Table 4

 Cardiovascular risk assessment in people with atherosclerotic cardiovascular disease and their families

People with atherosclerotic cardiovascular disease
γGT, γ glutamyl transferase; TSH, thyroid stimulating hormone; T4, thyroxine.
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
Physical activityProfessional assessment ideally by a physical activity specialist
Exercise tolerance test
Other risk factors
Body weight and distributionMeasure 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
Measure height where necessary and together with weight 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 validated device that is properly maintained and calibrated using the British Hypertension Society recommendations
In people with an acute atherosclerotic event it is necessary to monitor blood pressure after the acute event to ensure target blood pressure is achieved and maintained. Once the blood pressure target is achieved blood pressure should be measured at least annually
LipidsIn people with an acute atherosclerotic event measure random (non-fasting) total cholesterol as soon as possible. As concentrations of total cholesterol, LDL cholesterol, and HDL cholesterol fall (and triglycerides may rise) with an acute atherosclerotic event, or arterial surgery, a full fasting lipoprotein profile (total cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol) should be measured about 8 weeks following the event. Secondary causes of dyslipidaemia which have not already been investigated should be assessed at the same time: γGT and other liver function tests for alcohol abuse; T4 and TSH for hypothyroidism; creatinine for renal disease; fasting glucose for diabetes mellitus. Total cholesterol (non-fasting) 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. Once the lipid targets are achieved a full fasting lipid profile should be measured at least annually
GlucoseIn people with an acute atherosclerotic event measure random (non-fasting) plasma glucose as soon as possible followed by a fasting glucose
If random glucose ⩾11.1 mmol/l and/or FPG ⩾7.0 mmol/l then repeat fasting glucose on a different day. If a second FPG is ⩾7.0 mmol/l the diagnosis of diabetes mellitus is confirmed. In people with non-acute atherosclerotic disease measure fasting plasma glucose. If FPG is ⩾7.0 mmol/l then repeat the test on a different day, and if FPG is still ⩾7.0 mmol/l the diagnosis of diabetes mellitus is confirmed
People with diabetes mellitus should have fasting plasma glucose and HbAlc monitored to ensure targets are achieved and maintained
People with impaired fasting glycaemia (fasting glucose ⩾6.1 and <7.0 mmol/l) are at increased risk of developing diabetes mellitus. Fasting glucose should be measured annually
Family history: relatives of people with premature CVDFirst 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