Table 3

 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.
Smoking habitReported 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
DietProfessional 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 activityProfessional assessment ideally by a physical activity specialist
Other risk factors
Body weight and distributionMeasure weight and waist circumference
White caucasians: menWhite caucasians: women
<102 cm: normal<88 cm: normal
⩾102 cm: central obesity⩾88 cm: central obesity
Asians: menAsians: 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 pressureMeasure 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
LipidsMeasure 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
GlucoseMeasure 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
HbA1c (%)⩽ 6.16.2–7.5⩾ 7.5
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 historyFirst 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