CVD Risk Assessment Flashcards
What is cardiovascular disease (CVD)?
An umbrella term that describes a range of conditions that affect the heart, the blood vessels, or both. It is caused by blood clots (thrombosis) or atherosclerosis.
What is atherosclerosis?
Atherosclerosis is a condition where there is a build up of fatty deposits (plaques) inside an artery that cause the artery to harden and narrow, restricting blood flow.
Give examples of cardiovascular conditions by atherosclerosis
Cardiovascular conditions caused by atherosclerosis include:
- Coronary heart disease (including angina and myocardial infarction)
- Stroke
- Transient ischaemic attack (TIA)
- Peripheral arterial disease
What % of deaths in the UK are linked to CVD?
25%
What are the non-modifiable risk factors for CVD?
- Age
- Gender- at all ages men have a higher risk of CVD than women
- Family history of CVD
- Ethnic background- people of South Asian or sub-Saharan African origin have an increased risk of CVD
What are the modifiable risk factors for CVD?
- Smoking
- Low blood level of high-density lipoprotein (HDL) cholesterol
- High blood level of non-HDL cholesterol
- Sedentary lifestyle/lack of physical activity
- Unhealthy diet
- Alcohol intake above recommended levels
- Overweight and obesity
What comorbidities can increase the risk of CVD?
- Hypertension
- Diabetes mellitus (and pre-diabetes/metabolic syndrome)
- Chronic kidney disease
- Dyslipidaemia (familial and non-familial)
- Atrial fibrillation
- Rheumatoid arthritis, systemic lupus erythematosus, and other systemic inflammatory disorders
- Influenza
- Serious mental health problems (schizophrenia, post-traumatic stress disorder)
Briefly describe the The Health Check Programme in England
Everyone aged 40–74 years, who has not already been diagnosed with CVD, diabetes, or chronic kidney disease, is invited every 5 years for a free health check.
The health check includes a CVD risk assessment, an assessment of alcohol consumption, physical activity, cholesterol level, body mass index (BMI), an assessment for dementia in those aged 65-74 years, and screening for diabetes mellitus and chronic kidney disease in those at increased risk of developing these conditions.
What assessment tool is used to assess CVD risk?
QRISK assessment tool
In which groups of patients is the QRISK tool not used in to assess CVD risk?
- Who already have CVD
- At high risk of developing CVD because of familial hypercholesterolaemia, or other inherited disorders of lipid metabolism
- Aged 85 years or over- consider these people to be at high risk of developing CVD because of age alone
Describe the role of QRISK tool in people with type 1 diabetes mellitus or chronic kidney disease (CKD) stages 3, 4, or 5
These people are considered at high risk and so a CVD risk assessment is not required. However, it may help some people with these conditions make an informed choice on whether to take a statin.
What information is used to complete QRISK score?
Personal details- age, sex, ethnicity, postcode.
Clinical information- smoking status, and selected medical and family history, systolic blood pressure and standard deviation of at least two most recent systolic blood pressure readings, height and weight, and the total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio from a non-fasting blood sample.
How often should the QRISK score be repeated?
Note: if no changes occur
Repeat the assessment every five years, but earlier if any significant changes occur in the family history or knowledge of the family history.
Briefly describe the results of the QRISK score
QRISK calculates a 10-year estimated risk of CVD.
The QRISK risk score is expressed as a percentage (%). For example, if a person has a 20% estimated risk, the following kind of phrases may be useful:
- This means that you have a 20 in 100 chance (2 in 10 chance) of developing a cardiovascular disease CVD (CVD) within 10 years (angina, myocardial infarction, transient ischaemic attack, stroke or peripheral arterial disease.)
- In other words, in this example, 2 in 10 people with the same risk factors will develop a CVD within the next 10 years.
- The score cannot predict what will happen to each individual person.
Briefly describe the management for a QRISK score <10%
For people with an estimated cardiovascular disease (CVD) risk score of less than 10% using the QRISK assessment tool:
- 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
