5.3 CVD Risk Scoring

Question 1

What are modifiable risk factors of CVD disease?

Answer 1

Diet
Exercise
Smoking
Physical activity 
[non-HDL cholesterol]
Excess alcohol
Weight

Question 2

What are non-modifiable risk factors of CVD?

Answer 2

Genetic predisposition, age, familial history, ethnicity, male sex, post menopausal

Question 3

What comorbidities are risk factors of CVD?

Answer 3

Hypertension, diabetes, CKD, dyslipidaemia, influenza, mental health conditions,rheumatoid arthritis, periodontitis

Question 4

What is meant by CVD risk?

Answer 4

estimation of developing a CVD (angina, AMI, TIA, stroke, peripheral arterial
disease…). Risk scoring tools are based on a 10 year risk – they tend to underestimate

Question 5

What is the NHS health check programme?

Answer 5

national risk assessment, awareness and management programme for those aged 40 to 74 living in England who do not have an existing vascular condition, and who are not currently being treated for certain risk factors
Aimed at preventing heart disease, stroke, diabetes and kidney disease. Offered every five years
Systematically targets the top seven causes of premature mortality.

Question 6

When is statin intervention considered for primary prevention?

Answer 6

When risk of CVD is greater than 10%

Question 7

What tool does NHS England use to assess CVD risk?

Answer 7

QRISK

Previously used Manchester tables

Question 8

Why has the number of people taking statins increased?

Answer 8

Nice guidelines have changed as Move from CVD risk of > 20% to >10% leads to ↓9,000 deaths and ↓50,000 non-fatal events over 3
years

Question 9

Why are QRISK scores used instead of the Manchester tables?

Answer 9

As Manchester tables do not consider ethnicity, diabetes status, height, weight

Question 10

What interventions can be used for people with an estimated cardiovascular disease (CVD) risk score of less than 10% using the QRISK assessment tool?

Answer 10

Advise that although the risk is low, further reductions in risk can often still be achieved.
Offer advice on any relevant lifestyle factors that can be improved.
Consider reviewing any relevant comorbidities that may not be optimally treated.
Advise that a further risk assessment should be considered in 5 years.

Question 11

In patient with a CVD risk score of over 10%, what should be done before offering statin treatment?

Answer 11

Judge likelihood of familial lipid disorder (lipid profile/clinical findings/family history)
Exclude secondary causes of dyslipidaemia
Discuss the benefit of lifestyle modifications and optimize the management of all other modifiable
CVD risk factors, including any relevant comorbidities that may not be optimally treated.
Offer opportunity to reassess CVD risk again after lifestyle modifications.