Treatable or partially treatable risk factors
- High blood pressure
You should have your blood pressure checked at least every 3-5 years. High blood pressure (hypertension) usually causes no symptoms, so you will not know if it is high unless you have it checked. However, over the years, high blood pressure may do some damage to the arteries and put a strain on your heart.
Sometimes high blood pressure can be lowered by: losing weight if you are overweight, regular physical activity and eating healthily as described above. Medication may be advised if your blood pressure remains high. See separate leaflet called High blood pressure (hypertension) for details.
7 ways to improve your diet
- Eat at least five portions, and ideally 7-9 portions, of a variety of fruit and vegetables per day.
- The bulk of most meals should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.
- Limit your intake of fatty food, such as fatty meats, cheeses, full-cream milk, fried food and butter. Use low-fat, monounsaturated or polyunsaturated spreads.
- Include 2-3 portions of fish per week, at least one of which should be 'oily' (such as herring, mackerel, sardines, kippers, pilchards, salmon or fresh tuna).
- If you eat meat, it is best to eat lean cuts, or poultry such as chicken.
- If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.
- Try not to add salt to food and limit foods which are salty.
More
Now you have read 7 ways to improve your diet, why not look at some of our other slideshows.
Cholesterol and other lipids
In general, the higher the blood cholesterol level, the greater the risk of developing cardiovascular diseases. Having a high cholesterol level is more risky if you also have other risk factors such as diabetes or high blood pressure. As a rule, no matter what your cholesterol level is, lowering the level reduces your risk. This is why people at high risk of developing a cardiovascular disease are offered medication to lower their cholesterol level. See separate leaflet called Cholesterol for details.
A high blood level of triglyceride, another type of lipid (fat), also increases the health risk.
Diabetes and kidney disease
The increased risk that diabetes and kidney disease pose to developing cardiovascular diseases can be modified. For example, good control of blood sugar levels in people with diabetes reduces the risk. Good control of blood pressure in people with diabetes and kidney diseases reduces the risk.
Calculating your cardiovascular health risk
A 'risk factor calculator' is commonly used by GPs and practice nurses. This can assess your cardiovascular health risk. A score is calculated which takes into account all your risk factors such as age, sex, smoking status, blood pressure, cholesterol level, etc. The calculator has been devised after a lot of research that monitored thousands of people over a number of years. The score gives a fairly accurate indication of your risk of developing a cardiovascular disease over the next 10 years.
Who should have their cardiovascular health risk assessed?
Current UK guidelines advise that the following people should be assessed to find their cardiovascular health risk:
- All adults aged 40 or more.
- Adults of any age who have:
A strong family history of early cardiovascular disease. This means if you have a father or brother who developed heart disease or a stroke before they were aged 55, or in a mother or sister before they were aged 65.
A first-degree relative (parent, brother, sister, child) with a serious hereditary lipid disorder. For example, familial hypercholesterolaemia or familial combined hyperlipidaemia. These diseases are uncommon.
If you already have a cardiovascular disease or diabetes then your risk does not need to be assessed. This is because you are already known to be in the high-risk group.
What does the assessment involve?
A doctor or nurse will:
- Do a blood test to check your cholesterol and glucose (sugar) level.
- Measure your blood pressure and your weight.
- Ask you if you smoke.
- Ask if there is a history of cardiovascular diseases in your family (your blood relations); if so, at what age the diseases started in the affected family members.
- A score is calculated based on these factors plus your age and your sex. An adjustment to the score is made for certain other factors such as strong family history and ethnic origin.
There are many different calculators. The Framingham calculator has been used for a long time. Many health professionals are moving over to QRISK®2 which is more accurate and takes into account many other factors, such as whether you have a condition called atrial fibrillation, or kidney disease. The QRISK®2 calculator can be found online at www.qrisk.org
What does the assessment score mean?
You are given a score as a % chance. So, for example, if your score is 30%, this means that you have a 30% chance of developing a cardiovascular disease within the next 10 years. This is the same as saying a 30 in 100 chance (or a 3 in 10 chance). In other words, in this example, 3 in 10 people with the same score that you have will develop a cardiovascular disease within the next 10 years. Note: the score cannot say if you will be one of the three. It cannot predict what will happen to each individual person. It just gives you the odds.
You are said to have a:
- High risk - if your score is 20% or more. This is a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
- Moderate risk - if your score is 10-20%. This is between a 1 in 10 and 2 in 10 chance. This should be re-assessed every year.
- Low risk - if your score is less than 10%. This is less than a 1 in 10 chance. This should be re-assessed every 5 years.
Who should be treated to reduce their cardiovascular health risk?
Treatment to reduce the risk of developing a cardiovascular disease is usually offered to people with a high risk. That is:
- People with a risk assessment score of 20% or more. That is, if you have a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
- People with an existing cardiovascular disease. This is to lower the chance of it getting worse, or of developing a further disease.
- People with diabetes. The time that treatment to reduce cardiovascular risk is started depends on factors such as: your age, how long you have had diabetes, your blood pressure, and if you have any complications of diabetes.
- People with certain kidney disorders.
What treatments are available to reduce the risk?
If you are at high risk
If you are at high risk of developing a cardiovascular disease then treatment with medicines is usually advised along with advice to tackle any lifestyle issues.
This usually means:
- Treatment with medication, usually with a statin medicine, to lower your cholesterol level. No matter what your current cholesterol level, treatment with medicines is advised. In terms of targets, your level of cholesterol has to be viewed as part of your overall cardiovascular health risk. The cardiovascular health risk from any given level of cholesterol can vary, depending on the level of your HDL cholesterol, and on other health risk factors that you may have.
- Treatment with medication to lower blood pressure if it is high. This is even if your blood pressure is just mildly high.
- Where relevant, to encourage you even more to tackle lifestyle risk factors. This means to:
Stop smoking if you smoke.
Eat a healthy diet - including keeping your salt intake to under 5 g a day.
Keep your weight and waist in check.
Take regular physical activity.
Cut back if you drink a lot of alcohol.
If available, and if required, you may be offered a referral to a specialist service. For example, to a dietician to help you to lose weight and eat a healthy diet, to a specialist stop smoking clinic, or to a supervised exercise programme.
For details on exactly how much risk is reduced by lowering and treating risk factors, see the guidance produced by Prodigy called 'Cardiovascular risk assessment and management' - in 'References', below.
What if I am at moderate or low risk?
If you are not in the high-risk category, it does not mean you have no risk - just a lesser risk. Treatment with medicines is not usually prescribed. However, you may be able to reduce whatever risk you do have even further by any relevant changes in lifestyle (as described above).
Some people with a moderate risk buy a low-dose statin medicine from a pharmacy, to lower their cholesterol level. Statin medicines are available on prescription and funded by the NHS if your risk is high. However, you need to buy them if your risk is not in the high category. But, if you do buy a statin and take it regularly, it is best to let your doctor know so that it can be put on your medical record.
- High blood pressure
- Eat at least five portions, and ideally 7-9 portions, of a variety of fruit and vegetables per day.
- The bulk of most meals should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.
- Limit your intake of fatty food, such as fatty meats, cheeses, full-cream milk, fried food and butter. Use low-fat, monounsaturated or polyunsaturated spreads.
- Include 2-3 portions of fish per week, at least one of which should be 'oily' (such as herring, mackerel, sardines, kippers, pilchards, salmon or fresh tuna).
- If you eat meat, it is best to eat lean cuts, or poultry such as chicken.
- If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.
- Try not to add salt to food and limit foods which are salty.
- All adults aged 40 or more.
- Adults of any age who have:
- Do a blood test to check your cholesterol and glucose (sugar) level.
- Measure your blood pressure and your weight.
- Ask you if you smoke.
- Ask if there is a history of cardiovascular diseases in your family (your blood relations); if so, at what age the diseases started in the affected family members.
- A score is calculated based on these factors plus your age and your sex. An adjustment to the score is made for certain other factors such as strong family history and ethnic origin.
- High risk - if your score is 20% or more. This is a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
- Moderate risk - if your score is 10-20%. This is between a 1 in 10 and 2 in 10 chance. This should be re-assessed every year.
- Low risk - if your score is less than 10%. This is less than a 1 in 10 chance. This should be re-assessed every 5 years.
- People with a risk assessment score of 20% or more. That is, if you have a 2 in 10 chance or more of developing a cardiovascular disease within the next 10 years.
- People with an existing cardiovascular disease. This is to lower the chance of it getting worse, or of developing a further disease.
- People with diabetes. The time that treatment to reduce cardiovascular risk is started depends on factors such as: your age, how long you have had diabetes, your blood pressure, and if you have any complications of diabetes.
- People with certain kidney disorders.
- Treatment with medication, usually with a statin medicine, to lower your cholesterol level. No matter what your current cholesterol level, treatment with medicines is advised. In terms of targets, your level of cholesterol has to be viewed as part of your overall cardiovascular health risk. The cardiovascular health risk from any given level of cholesterol can vary, depending on the level of your HDL cholesterol, and on other health risk factors that you may have.
- Treatment with medication to lower blood pressure if it is high. This is even if your blood pressure is just mildly high.
- Where relevant, to encourage you even more to tackle lifestyle risk factors. This means to:
No comments:
Post a Comment