Cardiovascular health risk assessment

Why is a cardiovascular risk assessment important?

Cardiovascular disease (CVD) accounts for almost a quarter of all deaths in the UK. Risk factors that increase the risk of developing CVD include:

• Risk factors that cannot be changed: age, being male, having a family history of CVD, and ethnic background (eg, people of South Asian origin have an increased risk).

• Risk factors that can be changed: smoking, high cholesterol, lack of physical activity, unhealthy diet, alcohol intake above recommended levels, being overweight.

Conditions that increase the risk of CVD include hypertension, diabetes mellitus, chronic kidney disease, high lipids, rheumatoid arthritis, influenza, serious mental health problems, and periodontitis (gum disease).

By having a cardiovascular risk assessment, you can get an accurate estimate of your risk of developing CVD over the following 10 years and ways that you can reduce this risk.

What is a cardiovascular health risk assessment?

A cardiovascular risk assessment is an assessment of a person's risk of cardiovascular disease (CVD), such as the risk of developing heart disease or a stroke, and provides an assessment of the degree of risk.

The assessment provides an estimate of your risk of developing CVD over the following 10 years.

Within the Health Check Programme in England, everyone aged 40-74 years, not already diagnosed with cardiovascular disease (CVD), diabetes, or chronic kidney disease, is invited every five years for a free health check, which includes and assessment of:

• CVD risk.

• Alcohol consumption.

• Physical activity.

• Cholesterol level.

• Body mass index (BMI).

• Dementia (in those aged 65-74 years).

The Health Check also includes screening for diabetes mellitus and chronic kidney disease if you are at increased risk.

Who should have a cardiovascular health risk assessment?

All adults aged 40 or more should have a CVD risk assessment every five years apart from those who people who are already known to be at high risk of CVD, which includes anyone:

• Already known to have CVD.

• Aged 85 years or over (are assumed to be at high risk because of age alone, if a smoker or with high blood pressure.

• Who is a person with familial hypercholesterolaemia, or other inherited disorders of lipid metabolism.

People with type 1 diabetes mellitus or chronic kidney disease stages 3, 4, or 5 are at high risk, and so a CVD risk assessment is not needed, but an assessment may help to make an informed choice on whether to take a medicine to reduce cholesterol (statin).

What does a cardiovascular health risk assessment 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 sugar (glucose) 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 QRISK®3 risk assessmentis used in England and Wales. This provides an estimate that is accurate for most people but may underestimate the CVD risk for some people if:

• They have received treatment for HIV.

• They are taking medicines that can cause high lipids (eg, immunosuppressants).

• They have high blood levels of triglycerides (above 4.5 mmol/L).

• They are already taking medicines to lower blood pressure or to lower cholesterol.

• They have recently given up smoking.

The assessment should be repeated every five years, but may be advised earlier if there are any changes that may affect your CVD risk.

What does the assessment score mean?

You are given a score as a percentage (%) chance. So, for example, if your score is 30% this means that you have a 30% chance of developing a cardiovascular disease within the following 10 years. This is the same as saying you have 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 following 10 years.

Who should be treated to reduce their cardiovascular health risk?

Everyone, including those at low risk of CVD, should follow lifestyle advice to help reduce CVD risk and stay healthy. The lifestyle advice includes:

• Not smoking.

• Weight loss if overweight or obese.

• Eating a healthy diet.

• Keeping alcohol intake within the recommended limits.

• Being physically active and having regular exercise.

Treatment with a medicine called a statin to reduce cholesterol is usually advised if you have an estimated 10-year CVD risk of 10% or more and if lifestyle interventions have not been effective. See also the leaflets on Statins and other Lipid-lowering Medicines and High Cholesterol.

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 your lifestyle (as described above).

Some people with a low risk buy a low-dose statin drug from a pharmacy to lower their cholesterol level. Statin medicines are available on prescription but only funded by the NHS if your risk is 10% or more.

If you do buy a statin and take it regularly, it is best to discuss this with a healthcare professional so that you can be advised about the risks and benefits of taking a statin.