Understanding The Risk Of Your Heart Diseases

Assessing (calculating) your cardiovascular health risk

A ‘risk factor calculator’ is commonly used which can assess your cardiovascular health risk. A score is calculated which takes into account all your risk factors such as age, sex, smoking status, blood pressure, cholesterol level, etc. The calculator has been devised after a lot of research that monitored thousands of people over a number of years. The score gives a fairly accurate indication of your risk of developing a cardiovascular disease over the next 10 years.

Who should have their cardiovascular health risk assessed?

Current UK guidelines advise that the following people should be assessed to find their cardiovascular health risk:

  • All adults aged 40 or more.
  • Adults of any age who have:
  1. 1.A strong family history of early cardiovascular disease. This means if you have a father or brother who developed heart disease or a stroke before they were aged 55, or in a mother or sister before they were aged 65.
  2. A first-degree relative (parent, brother, sister, child) with a serious hereditary lipid disorder. For example, familial hypercholesterolaemia or familial combined hyperlipidaemia. These diseases are uncommon.

If you already have a cardiovascular disease or diabetes then your risk does not need to be assessed. This is because you are already known to be in the high-risk group.

What does the assessment involve?

A doctor or nurse will:

  • Do a blood test to check your cholesterol and glucose (sugar) level.
  • Measure your blood pressure and your weight.
  • Ask you if you smoke.
  • Ask if there is a history of cardiovascular diseases in your family (your blood relations). If so, at what age the diseases started in the affected family members.

A score is calculated based on these factors plus your age and your sex. An adjustment to the score is made for certain other factors such as strong family history and ethnic origin. 

The calculators are evolving all the time. The one which has been used for a long time is called Framingham. However, many health professionals are moving over to QRISK®2 which is more accurate and takes into account many other factors, such as whether you have a condition called atrial fibrillation, or kidney disease. The QRISK®2 calculator can be found online at www.qrisk.org

What does the assessment score mean?

You are given a score as a % chance. So, for example, if your score is 30% this means that you have a 30% chance of developing a cardiovascular disease within the next 10 years. This is the same as saying a 30 in 100 chance (or a 3 in 10 chance). In other words, in this example, 3 in 10 people with the same score that you have will develop a cardiovascular disease within the next 10 years. Note: the score cannot say if you will be one of the three. It cannot predict what will happen to each individual person. It just gives you the odds.

You are said to have a:

  • High risk – if your score is 20% or more. That is, a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
  • Moderate risk – if your score is 10-20%. That is, between a 1 in 10 and 2 in 10 chance.
  • Low risk – if your score is less than 10%. That is, less than a 1 in 10 chance.

Who should be treated to reduce their cardiovascular health risk?

Treatment to reduce the risk of developing a cardiovascular disease is usually offered to people with a high risk. That is:

  • People with a risk assessment score of 20% or more. That is, if you have a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
  • People with an existing cardiovascular disease. This is to lower the chance of it getting worse, or of developing a further disease.
  • People with diabetes. If you have diabetes, the time that treatment is started to reduce cardiovascular risk depends on factors such as: your age, how long you have had diabetes, your blood pressure, and if you have any complications of diabetes.
  • People with certain kidney disorders.

What treatments are available to reduce the risk?

If you are at high risk

If you are at high risk of developing a cardiovascular disease then drug treatment is usually advised along with advice to tackle any lifestyle issues. This usually means:

  • Drug treatment, usually with a statin drug, to lower your cholesterol level. No matter what your current cholesterol level, drug treatment is advised. In terms of targets, your level of cholesterol has to be viewed as part of your overall cardiovascular health risk. The cardiovascular health risk from any given level of cholesterol can vary, depending on the level of your HDL cholesterol, and on other health risk factors that you may have.
  • Drug treatment to lower blood pressure if it is high. This is even if your blood pressure is just mildly high.
  • Where relevant, to encourage you even more to tackle lifestyle risk factors. This means to:
  1. Stop smoking if you smoke.
  2. Eat a healthy diet – including keeping your salt intake to under 6 g a day.
  3. Keep your weight and waist in check.
  4. Take regular physical activity.
  5. Cut back if you drink a lot of alcohol.
  • If available, and if required, you may be offered a referral to a specialist service. For example, to a dietician to help you to lose weight and eat a healthy diet, to a specialist stop smoking clinic, or to a supervised exercise programme.

What if I am at moderate or low risk?

If you are not in the high-risk category, it does not mean you have no risk – just a lesser risk. Drug treatment is not usually prescribed. However, you may be able to reduce whatever risk you do have even further by any relevant changes in lifestyle. Some people with a moderate risk buy a low-dose statin drug from a pharmacy to lower their cholesterol level.

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