Cardiovascular risk assessment in people at high risk of developing CVD and their families
| People at high risk of developing CVD (CVD risk ⩾20% over 10 years) or with blood pressure levels requiring antihypertensive therapy, or with lipid values requiring lipid lowering therapy or with diabetes mellitus | ||||
|---|---|---|---|---|
| BMI, body mass index; FPG, fasting plasma glucose; LDL, low density lipoprotein; OGTT, oral glucose tolerance test. | ||||
| Lifestyle | ||||
| Smoking habit | Reported smoking habit | |||
| Current, ex or lifelong non-smoker? | ||||
| If current or ex: | ||||
| Number of cigarettes/day and number of smoking years | ||||
| Readiness to quit smoking | ||||
| Diet | Professional assessment ideally by a dietician if centrally obese (see below), or overweight or obese (BMI ⩾30 kg/m2) or with impaired glucose regulation or diabetes | |||
| Physical activity | Professional assessment ideally by a physical activity specialist | |||
| Other risk factors | ||||
| Body weight and distribution | Measure weight and waist circumference | |||
| White caucasians: men | White caucasians: women | |||
| <102 cm: normal | <88 cm: normal | |||
| ⩾102 cm: central obesity | ⩾88 cm: central obesity | |||
| Asians: men | Asians: women | |||
| <90 cm: normal | <80 cm: normal | |||
| ⩾90 cm: central obesity | ⩾80 cm: central obesity | |||
| Where necessary height can also be measured to calculate BMI | ||||
| BMI = weight (kg)/height (m)2 | ||||
| BMI <25 kg/m2: desirable body weight | ||||
| 25–<30 kg/m2: overweight | ||||
| ⩾30 kg/m2: obese | ||||
| Blood pressure | Measure blood pressure with a device with validated accuracy that is properly maintained and calibrated using the British Hypertension Society recommendations | |||
| If the person is already on antihypertensive drug therapy the blood pressure level should be viewed in relation to the target of <140 and <85 mm Hg (and <130 and <80 mm Hg in higher risk people). Blood pressure should be monitored until target blood pressure is achieved and maintained | ||||
| If the blood pressure is ⩾140 mm Hg systolic and/or ⩾85 mm Hg diastolic (in higher risk people ⩾130 mm Hg systolic and/or ⩾80 mm Hg diastolic) then repeat measurements (two measurements at each visit) over four visits to determine blood pressure thresholds for treatment, including an assessment of target organ damage (see fig 3 on assessment of blood pressure) | ||||
| Once the blood pressure target is achieved blood pressure should be measured at least annually | ||||
| Lipids | Measure random (non-fasting) total cholesterol and a full fasting lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol and non-HDL cholesterol) | |||
| If the person is already on lipid lowering therapy the total blood cholesterol (and calculated LDL cholesterol) should be viewed in relation to the target of a total cholesterol <4.0 mmol/l and an LDL cholesterol <2.0 mmol/l. Total random (non-fasting) blood cholesterol should be monitored to ensure target total cholesterol is achieved and maintained. A full fasting lipid profile is required to calculate if the LDL cholesterol target is achieved (see fig 6 on assessment of lipids) | ||||
| Once the lipid targets are achieved a full fasting lipid profile should be measured at least annually | ||||
| Glucose | Measure non-fasting plasma glucose. If the PG is ⩾6.1 mmol/l but <7.0 mmol/l then repeat fasting glucose on a different day. If FPG is ⩾6.1 mmol/l and <7.0 mmol/l then measure a second FPG. If this is ⩾6.1 mmol/l and <7.0 mmol/l the diagnosis of impaired fasting glycaemia is made. If fasting glucose is ⩾7.0 mmol/l then repeat fasting glucose on a different day. If fasting glucose is still ⩾7.0 mmol/l the diagnosis of diabetes is confirmed. A single fasting glucose ⩾7.0 mmol/l in the presence of diabetic symptoms is diagnostic of diabetes mellitus (see fig 7 on assessment of glucose) | |||
| People with diabetes mellitus should have fasting plasma glucose and HbA1c measured and monitored to ensure targets are achieved and maintained. | ||||
| Glucose control assessment | ||||
| Non-diabetic | Adequate | Inadequate | ||
| HbA1c (%) | ⩽ 6.1 | 6.2–7.5 | ⩾ 7.5 | |
| FPG | ⩽6.0 | 6.1–7.0 | >7.0 | |
| People with impaired fasting glycaemia (fasting glucose ⩾6.1 and <7.0 mmol/l) or impaired glucose tolerance (2 hour plasma glucose ⩾7.8 mmol/l and <11.1 mmol/l in an OGTT) are at increased risk of developing diabetes mellitus. Fasting glucose should be measured annually | ||||
| Family history | First degree relatives (parents, siblings and offspring) of people with premature atherosclerotic disease (men <55 years and women <65 years) should be screened for cardiovascular risk factors including fasting lipids. People with familial hypercholesterolaemia or other dyslipidaemias which put affected family members at very high risk of premature coronary and other atherosclerotic disease will be detected | |||