Who and When to have a cardiac assessment?
UK guidelines recommend that all people aged 40 or more should have a routine cardiovascular risk assessment or heart screening test. A risk factor calculator is commonly used while screening for heart failure by doctors and nurses to assess the risk of you developing a cardiovascular disease such as: heart attack, angina, stroke, and peripheral vascular disease. Treatment is recommended if you have a high risk.
What are cardiovascular diseases?
Cardiovascular diseases are diseases of the heart or blood vessels that causes degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue (atheroma), and leading to restriction of the circulation and a risk of thrombosis and hardening of the arteries.
Sometimes blood clots form over a patch of atheroma. Depending on the site of the atheroma it can causes include heart attack, angina, stroke and peripheral vascular disease.
Who should have their cardiovascular health risk assessed?
All adults aged 30 or more.
Adults of any age who have:
A strong family history of an 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.
A first-degree relative (parent, brother, sister, child) with a serious hereditary lipid disorder. For example, familial hypercholesterolemia or familial combined hyperlipidemia. 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 heart screening involve?
A doctor or nurse will ask if you have any current lifestyle risk factors that increase your risk of developing a cardiovascular disease. These include: smoking, obesity, a poor diet, lack of physical activity, and drinking a lot of alcohol. You will then have a blood test to check your blood cholesterol and glucose (sugar) level. Your blood pressure will be measured. A score is calculated based on several of these risk factors, your age and sex. An adjustment to the score is made for certain other risk factors such as strong family history and ethnic origin.
There are many different calculators. The Framingham calculator has been used for a long time but many health professionals are moving over to QRISK®2. This is more accurate and takes into account many other factors such as whether you have a condition called atrial fibrillation, or kidney disease.
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). So in this example, 3 in 10 people with the same risk factors 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. This 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%. This is between a 1 in 10 and 2 in 10 chance. This should be re-assessed every year.
Low risk - if your score is less than 10%. This is less than a 1 in 10 chance. This should be re-assessed every 5 years.
If you are at moderate or high risk
If you are at moderate or high risk of developing a cardiovascular disease, then treatment with medicines is usually advised. Advice to tackle any lifestyle issues is also given. This usually means:
Treatment with medication to lower your cholesterol level, usually with a statin medicine. No matter what your current cholesterol level, treatment with medication is advised.
Treatment with medication to lower blood pressure if your blood pressure is high.
Where relevant, to encourage you to tackle lifestyle risk factors. This means to:
Stop smoking if you smoke.
Eat a healthy diet.
Keep your weight and waist in check.
Take regular physical activity.
Cut back if you drink a lot of alcohol.
You may be require a referral to specialist services. 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 program.
What if I am at low risk?
If you are at low risk, it does not mean you have no risk - just a lesser risk. Medication is not usually prescribed. However, you may be able to reduce whatever risk you do have even further by any relevant changes in lifestyle as described above.
For further information and to arrange an appointment please contact us
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