​                         Professor Francisco Leyva-León

​Basic assessment for coronary heart disease risk

​If you’re over 40, it is worth having a cardiovascular risk assessment. This involves:



• A clinical interview (history) by your GP or cardiologist, to assess lifestyle, smoking, physical activity, family history

• A clinical examination to establish whether there are any signs of heart disease. This should include weight, height and body mass index (BMI).

• A measurement of the pulse and blood pressure

• A heart trace (ECG)

• A lipids test, to include cholesterol and triglycerides

• A glucose test, to exclude diabetes

• An assessment of cardiovascular risk using a cardiovascular risk calculator​

 

Higher risks of coronary heart disease are found in the following circumstances:

 

• ​Hypertension

• Diabetes

• High cholesterol

• Significant family history (men <55 and women <65 years with one first-degree relative)

• Impaired fasting glucose 

• South Asian origin. If more than one first-degree relative is affected, the risk may be increased by a factor of up to 2

• Obesity (BMI=30 kg/m2)

• Serum triglyceride of 1.7 mmol/L or more increases cardiovascular risk by 1.3 times

• A low HDL cholesterol (<1.0 mmol/L in men and <1.2 mmol/L in women) 

• Left ventricular hypertrophy (LVH) - this can be diagnosed using echocardiography. An ECG is not reliable for detecting LVH.​



Additional tests



If you have no symptoms and your cardiovascular risk score is above that expected for your age, a calcium scoring scan may be useful.



If you do have symptoms of heart disease, it is important you see a cardiologist, who will guide further tests.

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Assessment of other cardiovascular risks

​Coronary heart disease is not the only condition that requires a cardiovascular risk assessment. Even if you do not have any symptoms, you should consider having specific cardiovascular risk assessments if there is a family history of:

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• Dilated cardiomyopathy

• Hypertrophic cardiomyopathy

• Brugada syndrome

• Long QT syndrome

• Sudden death due to heart disease

Links - cardiovascular risk calculators

Risk scoring systems are good for estimating the probability of coronary heart diease for individuals who have not already developed it. They are an aid to making clinical decisions about how intensively to intervene on lifestyle and whether to use antihypertensive, lipid lowering medication and aspirin.

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Here are some cardiovascular risk calculators:

http://www.qrisk.org

http://cvrisk.mvm.ed.ac.uk/calculator/calc.asp

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