CVD Risk Assessment

Question 1

What is cardiovascular disease (CVD)?

Answer 1

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.

Question 2

What is atherosclerosis?

Answer 2

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.

Question 3

Give examples of cardiovascular conditions by atherosclerosis

Answer 3

Cardiovascular conditions caused by atherosclerosis include:

• Coronary heart disease (including angina and myocardial infarction)
• Stroke
• Transient ischaemic attack (TIA)
• Peripheral arterial disease

Question 4

What % of deaths in the UK are linked to CVD?

Answer 4

25%

Question 5

What are the non-modifiable risk factors for CVD?

Answer 5

• 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

Question 6

What are the modifiable risk factors for CVD?

Answer 6

• 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

Question 7

What comorbidities can increase the risk of CVD?

Answer 7

• 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)

Question 8

Briefly describe the The Health Check Programme in England

Answer 8

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.

Question 9

What assessment tool is used to assess CVD risk?

Answer 9

QRISK assessment tool

Question 10

In which groups of patients is the QRISK tool not used in to assess CVD risk?

Answer 10

• 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

Question 11

Describe the role of QRISK tool in people with type 1 diabetes mellitus or chronic kidney disease (CKD) stages 3, 4, or 5

Answer 11

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.

Question 12

What information is used to complete QRISK score?

Answer 12

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.

Question 13

How often should the QRISK score be repeated?

Note: if no changes occur

Answer 13

Repeat the assessment every five years, but earlier if any significant changes occur in the family history or knowledge of the family history.

Question 14

Briefly describe the results of the QRISK score

Answer 14

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.

Question 15

Briefly describe the management for a QRISK score <10%

Answer 15

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

Question 16

What lifestyle advice is given to reduce CVD risk?

Answer 16

Advise that most people, if not all, will be able to reduce whatever risk they have of developing CVD by relevant changes to lifestyle- the three most important modifiable and causal CVD risk factors are smoking, hypertension and abnormal lipids.

• Advise smokers to stop and non-smokers to avoid passive smoking
• Advise weight loss if the person is overweight or obese
• Advise the person to adopt a diet that helps to reduce CVD risk
• Advise the person to keep alcohol consumption within the recommended limits
• Advise the person to be physically active and to avoid prolonged sedentary behaviour

Question 17

What diet is recommended to reduce CVD risk?

Answer 17

• Eating:
  
  • Unsalted nuts, seeds and legumes
  • Fish
  • Fruit and vegetables
  • Fibre
• Reducing:
  
  • Sugar, and food products containing refined sugars (including fructose)
  • Saturated fat
  • Salt
• Increasing mono-unsaturated fat intake with olive oil or rapeseed oil or spreads based on these oils

Question 18

Briefly describe the management for a QRISK score >10%

Answer 18

• Discuss the benefit of lifestyle modifications and optimise the management of all other modifiable CVD risk factors, including any relevant comorbidities that may not be optimally treated.
• Offer statin treatment after risk assessment if lifestyle modification is ineffective or inappropriate.

Question 19

What statin and dose is used in primary prevention of CVD?

Answer 19

Offer atorvastatin 20 mg a day (unless contraindicated) for the primary prevention of cardiovascular disease (CVD) to people with an estimated CVD risk of 10% or more.

Question 20

What statin and dose is used in secondary prevention of CVD?

Answer 20

Offer atorvastatin 80 mg a day (unless contraindicated) for the secondary prevention of cardiovascular disease (CVD).

Question 21

How is CVD risk managed in patients with chronic kidney disease?

Answer 21

For all people with CKD, prescribe lipid-lowering therapy with a statin, for the primary or secondary prevention of CVD. There is no need for a formal risk assessment as these patients are high risk.

Offer 20mg atorvastatin daily.

Question 22

How is CVD risk managed in type 1 diabetes?

Answer 22

With type 1 diabetes mellitus- consider offering statin treatment in all adults. Offer atorvastatin 20 mg to adults aged over 40 years, or who have had diabetes for more than 10 years, or who have established nephropathy, or have other CVD risk factors.