Who to assess for CVD risk?
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Consider a comprehensive cardiovascular risk assessment in all adults aged 40–80 years who attend their general practitioner, or other member of the primary care team, for whatever reason. Younger adults (<40 years) with a family history of premature atherosclerotic disease should also have their cardiovascular risk factors measured |
How to assess for total CVD risk?
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A short history, focused clinical examination, and a blood sample provide a simple, quick, practical assessment of an asymptomatic person’s total cardiovascular risk. Using the Joint British Societies, cardiovascular risk prediction charts you can estimate the probability (%) of developing CVD over a 10 year period. |
Which risk factors to measure?
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Age | □□ years |
Sex | Male/female |
Cigarette smoker (current or past) | Yes/No |
Systolic blood pressure (measured twice—use mean) | □□□ mm Hg |
Total cholesterol (non-fasting) | □□.□ mmol/l |
HDL cholesterol (non-fasting) | □.□ mmol/l |
TC: HDL-C ratio (if an HDL cholesterol measurement is not available assume it is 1.0) | □.□ |
Non-fasting plasma glucose (This measurement is not required for CVD risk calculation, but is the first step in the diagnosis of impaired glucose regulation and diabetes) | □□.□ mmol/l |
Calculate total CVD risk from the cardiovascular risk prediction charts
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Total CVD risk: □□ % |
A CVD risk ⩾20% over 10 years is defined as high risk and justifies professional lifestyle intervention and appropriate use of antithrombotic, antihypertensive, and lipid lowering therapy |
What about other CVD risk factors not included in the cardiovascular risk prediction charts?
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The following risk factors can all increase the risk of CVD above that calculated from the charts |
• Family history of premature CVD (men <55 years and women <65 years) |
• Obesity (body mass index ≥30 kg/m2) and especially central obesity (waist circumference in white caucasians ≥102 cm in men and ≥88 cm in women and in Asians ≥90 cm in men and ≥80 cm in women) |
• Low HDL cholesterol (<1.0 mmol/l in men and <1.2 mmol/l in women) |
Raised triglycerides (>1.7 mmol/l) |
• Impaired fasting glucose (⩾6.1 but <7.0 mmol/l) or impaired glucose tolerance (2 hour glucose ⩾7.8 mmol/l and <11.1 mmol/l in an oral glucose tolerance test) |
• Women with premature menopause |
So a physician should always use clinical judgement by taking account of these other risk factors in reaching a final decision about a person’s cardiovascular risk and their need for professional lifestyle intervention and drug therapy |
Which people should NOT have CVD risk calculated?
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The following people are at sufficiently high risk to justify professional lifestyle intervention and appropriate treatment with antithrombotic, antihypertensive and lipid lowering therapies without formal risk calculation: |
• People with atherosclerotic cardiovascular disease |
• Persistently elevated blood pressure (⩾160/100 mm Hg) or when target organ damage due to hypertension is present |
• TC to HDL-C ratio ⩾6 |
• Type 1 and 2 diabetes mellitus |
• Renal dysfunction including diabetic nephropathy |
• Familial hypercholesterolaemia, familial combined hyperlipidaemia, or other inherited dyslipidaemias |
Many people aged 70 years and older are at high cardiovascular risk and treatment of blood pressure and lipids is a matter for individual clinical management where a physician should also take account of co-morbidity and other factors |
What about calculating CVD risk in ethnic groups other than white caucasian?
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The cardiovascular risk prediction charts have not been validated in ethnic groups other than white caucasian and therefore they should be used with caution |