Heart disease: reduce the risk

Heart disease is rarely caused by just one thing. It most often results from an accumulation of risk factors. It is important that you know these factors and work to avoid or improve on any ones that are relevant to you.

An assessment of your risk of heart disease is best done by your doctor who can advise you on ways to reduce your risk factors.

Ways to reduce your risk of heart disease

• Keep your blood lipid levels low (cholesterol and triglycerides).
• Maintain a healthy weight.
• If you have diabetes, ensure it's controlled.
• Have your blood pressure checked regularly.
• Be physically active.
• Don’t smoke.

Keeping blood cholesterol and triglycerides low

Blood cholesterol and triglycerides are best measured as part of an overall assessment of your risk of heart disease. They can be measured by a simple blood test, which can be arranged by your doctor. Depending on your other risk factors (such as a family history of high cholesterol, or other existing conditions such as diabetes), your doctor may aim to get your total blood cholesterol level to about 4.0 mmol/L. Ask for further advice from your doctor.

To help keep cholesterol low, remember the following key points.

• Eat less fat, especially saturated animal fat.
• Achieve and maintain a healthy body weight.
• Keep active.

How do I eat less saturated fat?

• Use small amounts of margarine and monounsaturated and polyunsaturated oils (e.g. canola, olive, sunflower and safflower) instead of butter and other animal fats (such as dripping).
• Cut fat off meat.
• Remove skin from chicken.
• Grill meat instead of frying.
• Choose lower fat cheeses (such as Edam, mozzarella or cottage cheese).
• Use low-fat milk (less than 2 per cent fat).
• Avoid deep-fried, takeaway foods.
• Minimise your intake of cakes, biscuits, pastries and chocolate. Have them only occasionally.
• While most saturated fats have an animal source, some vegetable oils, such as palm oil and coconut oil (and coconut milk and cream), do contain high levels of saturated fat, and should also be avoided.

How do I maintain a healthy weight?

• Avoid foods high in fat: choose lean meats, cut the skin off chicken, choose low-fat dairy products and eat fish regularly. All fats, saturated or not, contain high levels of energy.
• Eat smaller portions.
• Reduce sugar and alcohol intake.
• Be physically active: choose activities that you enjoy and can keep up.
• If you are already overweight, you need to lose some weight. But it is important to do it slowly and properly. Avoid diets that promise rapid weight loss. Don't starve yourself or miss meals. Seek the advice of your doctor or a dietitian.

General rules of healthy eating

• Make vegetables a major part of at least one meal each day and eat fruit frequently. Recommendations are for 5 serves of vegetables and 2 serves of fruit daily.
• Choose wholegrain breads instead of white varieties more often.
• Eat more cereals (rice, pasta and other grains) and legumes (dried peas and beans).
• Use only small amounts of very lean meats and poultry without skin.
• Choose low-fat dairy products (milk, yoghurt and cheese).
• Try to eat fish at least twice a week (tinned or fresh), but make sure it isn't fried.
• Avoid high fat and/or high sugar bakery products, fast foods, desserts, soft drinks and confectionery.
• Use small amounts of margarine or olive oil instead of butter.
• Use monounsaturated or polyunsaturated oils for cooking (e.g. olive, canola, sunflower and safflower).
• Grill, boil, steam, bake or microwave rather than fry.
• Reduce your salt intake.
• Look for the Heart Foundation Tick for healthy food choices.
• Drink plenty of water.

Why is it important to control diabetes?

People with diabetes have a greater chance of developing heart disease than those who don't have diabetes. Diabetes can affect the vessels that supply blood to the heart. Working with your doctor to develop a plan to control your diabetes is the first step in safeguarding your heart.

Many of the lifestyle changes suggested for keeping your heart healthy, such as a good diet and regular exercise, are also important in controlling diabetes. Sometimes medication is needed. Ask your doctor.

Why should I be physically active?

Active people have fewer heart attacks and have a better chance of recovery than inactive people. They also:

• feel good, are less tired, more relaxed and are better able to cope with stress;
• can do more with less effort;
• have better heart function and possibly lower blood pressure; and
• can control their weight and lower their blood cholesterol levels.

Aim to accumulate 30 minutes of physical activity most days of the week. You don't have to join a gym or pound the pavements all day long. Regular brisk walking for half an hour can do the job just as well. Find a variety of activities you enjoy. Look for opportunities to put activity in your day, such as taking the stairs instead of the lift or parking your car a little further away. Every bit helps. Two or 3 sessions that add up to half an hour are OK if you can't do it all at once.

Why is blood pressure important?

High blood pressure can enlarge and weaken the heart. It also damages the blood vessels. If they become narrow or blocked, it may result in a heart attack or stroke. Have your blood pressure checked regularly.

Your doctor can tell you how often is advisable: your blood pressure needs to be checked more often if you are older, taking any medication (including the contraceptive pill), if you are overweight, or if you have diabetes or a family history of heart disease.

How does smoking affect my heart?

If you smoke, your chances of a heart attack are 2 or 3 times more than a non-smoker, and you have a higher risk of stroke and many other diseases. Lifetime smokers have a one in 2 chance of dying from smoking and shorten their lives by an average of 14 years. Smoking also adversely affects the health of others around you.

Is it worth stopping smoking?

YES. Always. Whatever your age, whatever your health. If you stop smoking, the risks mentioned above soon become much less.

How do I stop?

• Set a quit day and go for it.
• Ring the Quitline for free advice and support (131 848).
• Do something different at times when you usually smoke.
• Get your friends to support you.
• Avoid smokers and places where a lot of people smoke.
• Be more physically active.
• Try chewing gum or nibbling on raw fruits or vegetables.
• Promise yourself a treat with the money you save.
• Don’t be put off by one failure: try again and again if necessary.
• Talk to your doctor or pharmacist about nicotine replacement or other prescription medicines to help with cravings.
• Enrol for a stop smoking programme: talk to your doctor.

Should we be stressed about stress?

The exact relationship between stress and heart disease is unclear. However, for our general health and well-being, it is advisable to understand what things stress us unduly, and to find ways of dealing with them.

Here are some helpful ways of reducing stress.

• Identify the cause.
• Be more physically active.
• Relax physically and mentally.
• Maintain healthy eating habits.
• Establish regular sleep patterns.

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How Can a Heart Attack Be Prevented?

Lowering your risk factors for coronary heart disease (CHD) can help you prevent a heart attack. (For more information about risk factors, go to "Who Is at Risk for a Heart Attack?")

Even if you already have CHD, you can still take steps to lower your risk for a heart attack. These steps involve following a heart healthy lifestyle and getting ongoing care.

Heart Healthy Lifestyle

Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugars.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources provide general information about healthy eating.

If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan that involves diet and physical activity. Controlling your weight helps you control risk factors for CHD and heart attack.

Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.

For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's "Your Guide to Physical Activity and Your Heart."

If you smoke, quit. Smoking can raise your risk of CHD and heart attack. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. For more information about quitting smoking, go to the Health Topics Smoking and Your Heart article.

Ongoing Care

Treat Related Conditions

Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include:

• High blood cholesterol. Your doctor may prescribe medicine to lower your cholesterol if diet and exercise aren't enough.
• High blood pressure. You doctor may prescribe medicine to keep your blood pressure under control.
• Diabetes (high blood sugar). If you have diabetes, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed.

Have an Emergency Action Plan

Make sure that you have an emergency action plan in case you or someone in your family has a heart attack. This is very important if you're at high risk for a heart attack or have already had a heart attack.

Write down a list of medicines you are taking, medicines you are allergic to, your health care provider's phone numbers (both during and after office hours), and contact information for a friend or relative. Keep the list in a handy place to share in a medical emergency (for example, fill out this wallet card).

Talk with your doctor about the signs and symptoms of a heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.

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Causes and Prevention of Heart Disease

It’s true: Heart disease is the No. 1 killer in women. Yet, only 1 in 5 American women believe that heart disease is her greatest health threat.

Take Amy Heinl, for example, an avid marathon runner and fitness devotee. Heart disease was the furthest thing from her mind – until she collapsed during an early-morning workout. A diagnosis of heart disease followed, and it took her completely by surprise.

“I really couldn’t believe this happened to me,” Amy says. “I thought of myself as a healthy person, and I was exercising when it happened. I truly believed I had pulled a muscle.” Which is why her friend called 9-1-1, not Amy.

The truth is, women are less likely to call 9-1-1 when experiencing symptoms of a heart attack themselves. It simply doesn’t occur to them to do so. And why would it? The bulk of media attention on the disease is focused on men.

Here are more unsettling facts:

• Heart disease causes 1 in 3 women’s deaths each year, killing approximately one woman every minute.

• 90 percent of women have one or more risk factors for developing heart disease.

• Since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to widen.

• The symptoms of heart disease can be different in women vs. men, and are often misunderstood.

• While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease.

It’s time to focus on finding, and becoming the solution. Here’s what you need to know about the causes of heart disease and ways you can prevent it.

What causes heart disease?

Heart disease affects the blood vessels and cardiovascular system. Numerous problems can result from this, many of which are related to a process called atherosclerosis, a condition that develops when plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke.

But it doesn’t end there. Heart disease can take many other forms as well:

• Heart failure or congestive heart failure, which means that the heart is still working, but it isn’t pumping blood as well as it should, or getting enough oxygen.

• Arrhythmia or an abnormal rhythm of the heart, which means the heart is either beating too fast, too slow or irregularly. This can affect how well the heart is functioning and whether or not the heart is able to pump enough blood to meet the body’s needs.

• Heart valve problems can lead to the heart not opening enough to allow proper blood flow. Sometimes the heart valves don’t close and blood leaks through, or the valve leaflets bulge or prolapse into the upper chamber, causing blood to flow backward through them.

How can I prevent it?

Many things can put you at risk for these problems – one’s you can control, and others that you can’t. But the key takeaway is that with the right information, education and care, heart disease in women can be treated, prevented and even ended.

Studies show that healthy choices have resulted in 330 fewer women dying from heart disease per day. Here are a few lifestyle changes you should make:

• Don’t smoke
• Manage your blood sugar
• Get your blood pressure under control
• Lower your cholesterol
• Know your family history
• Stay active
• Lose weight
• Eat healthy

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Heartburn Prevention Tips for Spicy Food Lovers

I love a hot, spicy meal. But an hour later, like many people, I can end up wishing I’d never lifted my fork. The culprit? Heartburn and acid reflux. Officially known as gastroesophageal reflux disease, or GERD, acid reflux occurs when food and stomach acids escape up into the esophagus through the valve at the top of the stomach. That causes the burning sensation that can sometimes rise up into the throat, known as heartburn.

Surveys of heartburn sufferers suggest spicy foods are among of theworst offenders. Whether spicy foods  deserve their reputation is controversial, I’ve discovered. Many different foods can trigger heartburn.But luckily, you don’t have to say no to Chinese kung pao chicken, Mexican salsa, or fiery Thai noodle dishes. A few practical tips can help you put out the fire of heartburn before it starts.

Researchers have compiled a long list of foods that seem to trigger heartburn. These include alcohol, citrus fruits and juices, carbonated beverages, coffee and caffeine, chocolate, tomato sauce, fatty foods, mint, and, of course, spicy foods.

“But no single food stands out,” says Anish Sheth, MD, assistant professor of medicine at Yale University and co-author ofWhat’s Your Poo Telling You? “For some people, the same food can cause problems after one meal but not after others.”

In theory, foods most likely to cause acid reflux and symptoms of heartburn are those that cause the valve at the top of the stomach to relax. Mint, alcohol, and caffeinated coffee, among other foods, are believed to have that effect.

Yet when gastroenterologist Lauren B. Gerson, MD, an associate professor of medicine at Stanford University, and colleagues looked at trials designed to test the effects of these and other particular foods on heartburn symptoms, they found very little evidence to support the associations.

Even spicy foods may not deserve their reputation as being the worst culprits. Sure they taste hot, but that doesn’t mean they cause acid reflux. They may simply irritate the stomach.

“Still,” Gerson says, “it’s commonsense that if a particular food happens to cause you problems, the best advice is to avoid it.”

Since even heartburn sufferers can be misled by popular misconceptions, experts recommend keeping a food diary for several weeks.

“As soon as heartburn strikes, jot down what and how much you ate,” suggests dietitian Elaine Magee, author of Tell Me What to Eat If I Have Acid Reflux. “Also keep track of foods you thought might cause trouble but don’t. That way you won’t have to eliminate foods unnecessarily.”

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Prevent and Manage Heartburn

Heartburn relief can be achieved by some simple lifestyle and diet changes. Here are some suggestions for preventing and managing heartburn.

• Don't go to bed with a full stomach. Eat meals at least 2 hours to 3 hours before lying down -- this will give food time to digest and empty from your stomach, and acid levels a chance to decrease before you lay down.
• Don't overeat. Decrease the size of portions at meal times or try eating 4 to 5 small meals instead of 3 large ones.
• Eat slowly. Take time to eat -- don't rush. Try putting your fork down between bites.
• Wear loose-fitting clothes.
• Avoid heartburn triggers. Stay away from foods and beverages that trigger your heartburn symptoms (for example, onions, peppermint, chocolate, caffeinated beverages such as coffee, citrus fruits or juices, tomatoes, or high-fat foods). A good way to figure out what foods cause your heartburn symptoms is to keep a food diary.
• Shed some pounds. If you are overweight, losing weight can help relieve heartburn symptoms.
• Stop smoking. Nicotine, one of the main active ingredients in cigarettes, can weaken the lower esophageal sphincter, the muscle that controls the opening between the esophagus and stomach, allowing the acid-containing contents of the stomach to enter the esophagus.
• Avoid alcohol. If your aim is to unwind after a stressful day, try exercise, meditation, stretching, or deep breathing instead of drinking alcohol.
• Keep a diary or heartburn log. Keep track of when heartburn hits and the specific activities that seem to trigger the incidents.

If Your Heartburn Is Worse When Lying Down:

• Raise the head of your bed so that your head and chest are higher than your feet. You can do this by placing 6-inch blocks under the bedposts at the head of the bed. Don't use piles of pillows to achieve the same goal. You will only put your head at an angle that can increase pressure on your stomach and make your heartburn worse.
• Eat earlier. Try not to eat within 3 hours of going to bed.

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Preventing Cardiovascular Diseases

The cause of most cardiovascular disease is a build-up of atheroma - a fatty deposit within the inside lining of arteries. Lifestyle factors that reduce the risk of forming atheroma include: not smoking, choosing healthy foods, a low salt intake, regular physical activity, keeping your weight and waist size down, and drinking alcohol in moderation. Your blood pressure and cholesterol level are also important. All people aged over 40 should have a cardiovascular risk assessment - usually available at your GP surgery. If you have a high risk of developing a cardiovascular disease, treatment to reduce high blood pressure and/or cholesterol may be advised.

What is cardiovascular disease?

Cardiovascular diseases are diseases of the heart (cardiac muscle) or blood vessels (vasculature). However, in practice, when doctors use the term cardiovascular disease they usually mean diseases of the heart or blood vessels that are caused by atheroma. The rest of this leaflet briefly discusses atheroma, the diseases atheroma can cause, and ways of preventing a build-up of atheroma and preventing the diseases it causes.

What is atheroma (atherosclerosis)?

Patches of atheroma are like small fatty lumps that develop within the inside lining of arteries (blood vessels). Atheroma is also known as atherosclerosis and hardening of the arteries. Patches of atheroma are often called plaques.

A patch of atheroma makes an artery narrower. This can reduce the blood flow through the artery. In time, patches of atheroma can become larger and thicker.

Sometimes, a patch of atheroma may develop a tiny crack on the inside surface of the blood vessel. This may trigger a blood clot (thrombosis) to form over the patch of atheroma, which may completely block the blood flow. Depending on the artery affected, a blood clot that forms on a patch of atheroma can cause a heart attack, a stroke, or other serious problems.

See separate leaflet called Atheroma for more details.

What are the cardiovascular diseases caused by atheroma?

Heart disease

The term heart disease (or coronary heart disease) is used for conditions caused by narrowing of the coronary (heart) arteries by atheroma. The problems this can cause include angina, heart attack, and heart failure.

Heart disease is common in the UK in people aged over 50.

Note: it can be confusing, as there are other heart conditions such as heart valve problems, congenital heart problems, etc. However, these are not usually included when we talk about 'heart disease'.

Cerebrovascular disease - stroke and transient ischaemic attack (TIA)

Cerebrovascular disease means a disease of the arteries in the brain (cerebrum). The problems this can cause include a stroke and a transient ischaemic attack (TIA). A stroke means that part of the brain is suddenly damaged. The common cause of a stroke is due to an artery in the brain, which becomes blocked by a blood clot (thrombus). The blood clot usually forms over some atheroma. A TIA is a disorder caused by temporary lack of blood supply to a part of the brain.

Peripheral arterial disease

Peripheral arterial disease is narrowing (due to atheroma) that affects arteries other than arteries in the heart or brain. The arteries that take blood to the legs are the most commonly affected.

If you can prevent a build-up of atheroma in the arteries, you are less likely to develop the above diseases. If you already have one of the above diseases, you may prevent or delay it from getting worse if you prevent further build-up of atheroma.

Everybody has some risk of developing atheroma. However, certain risk factors increase the risk. Risk factors include:

Risk factors

• Lifestyle risk factors that can be prevented or changed:
• Smoking.
• Lack of physical activity.
• Obesity.
• An unhealthy diet and eating too much salt.
• Excess alcohol.
• Treatable or partly treatable risk factors:Hypertension (high blood pressure).
• High cholesterol blood level.
• High triglyceride (fat) blood level.
• Diabetes.
• Kidney diseases causing diminished kidney function.
• Fixed risk factors - ones that you cannot alter:A strong family history. This means if you have a father or brother who developed heart disease or a stroke before they were 55, or in a mother or sister before they were 65.
• Being male.
• Severe baldness in men at the top of the head.
• An early menopause in women.
• Age. The older you become, the more likely you are to develop atheroma.
• Ethnic group. For example, people who live in the UK with ancestry from India, Pakistan, Bangladesh, or Sri Lanka have an increased risk.

However, if you have a fixed risk factor, you may want to make extra effort to tackle any lifestyle risk factors that can be changed.

Note: some risk factors are more risky than others. For example, smoking probably causes a greater risk to health than obesity does. Also, risk factors interact. So, if you have two or more risk factors, your health risk is much more increased than if you just have one. For example, an Oxford study found that men aged 50 who smoke, have high cholesterol and have high blood pressure, die, on average, 10 years earlier than men who do not have these risk factors.

Research is looking at some other factors that may be risk factors. For example, high blood levels of fibrinogen, C-reactive protein, apolipoprotein B, and homocysteine are being investigated as possible risk factors.

Known risk factors that can be prevented, changed or treated are now discussed further.

Lifestyle risk factors that can be prevented and/or changed

Smoking

Lifetime smoking roughly doubles your risk of developing heart disease. The chemicals in tobacco get into the bloodstream from the lungs and damage the arteries and other parts of the body. Your risk of having a stroke, and developing other diseases such as lung cancer are also increased. Stopping smoking is often the single most effective thing that a person can do to reduce their health risk. The increased risk falls rapidly after stopping smoking (although it takes a few years before the excess risk reduces completely). If you smoke and are having difficulty in stopping, then see your practice nurse for help and advice.

Lack of physical activity - a sedentary lifestyle

People who are physically active have a lower risk of developing cardiovascular diseases compared with inactive people. To gain health benefits you should do at least 30 minutes of moderate physical activity, on most days (at least five days per week).

• 30 minutes in a day is probably the minimum to gain health benefits. However, you do not have to do this all at once. For example, cycling to work and back 15 minutes each way adds up to the total of 30 minutes.
• Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. For example: brisk walking, jogging, swimming, cycling, etc. However, research studies do suggest that the more vigorous the exercise, the better for health - particularly for preventing heart disease.
• On most days. You cannot store up the benefits of physical activity. You need to do it regularly.

Being overweight

If you are overweight, you are more likely to develop cardiovascular diseases, diabetes, or certain cancers. The increased health risk of obesity is most marked when the excess fat is mainly in the abdomen rather than on the hips and thighs. As a rule, a waist measurement of 102 cm or above for men (92 cm for Asian men) and 88 cm or above for women (78 cm for Asian women) is a significant health risk.

Diet

Eating healthily helps to control obesity, and lower your cholesterol level. Both of these help to reduce your health risk. Also, there is some evidence that eating oily fish (herring, sardines, mackerel, salmon, kippers, pilchards, fresh tuna, etc) helps to protect against heart disease. It is probably the omega-3 fatty acids in the fish oil that help to reduce the build-up of atheroma. Also, fruit and vegetables, as well as being low in fat, also contain antioxidants and vitamins which may help to prevent atheroma from building up. Briefly, a healthy diet means:

• AT LEAST five portions, ideally more, 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.
• NOT MUCH fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low-fat, mono- or poly-unsaturated spreads. One study conducted at Harvard University found that replacing saturated fats with poly-unsaturated fats is an effective way of lowering your risk of heart attacks and other serious problems from heart disease.
• INCLUDE 2-3 portions of fish per week, at least one of which should be oily (such as herring, mackerel, sardines, kippers, salmon, or fresh tuna).
• LIMIT SALT to no more than 6 g a day (and less for children). See below for details.
• If you eat meat, it is best to eat lean meat, or poultry such as chicken.
• If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.

Salt

Adults should eat no more than 5 g of salt a day. This is about a teaspoon of salt. Even a modest reduction in intake can make quite a big difference. The current average daily intake of salt in the UK is 9 g per day. About three quarters of the salt we eat is already in the foods we buy. Simply checking food labels and choosing foods with lower salt options can make a big difference. A tip: sodium is usually listed on the food label. Multiplying the sodium content by 2.5 will give the salt content. Also, try not to add salt to food at the table.

Alcohol

Drinking a small or moderate amount of alcohol probably reduces the risk of developing cardiovascular diseases (38% compared with teetotallers in one study). That is, 1-2 units per day - which is up to 14 units per week. Drinking more than 15 units per week does not reduce the risk, and drinking more than the recommended upper limits can be harmful. That is, men should drink no more than 21 units per week (and no more than four units in any one day). Women should drink no more than 14 units per week (and no more than three units in any one day). One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.

Other 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.

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.

Cholesterol and other lipids

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?

• 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 dietitian to help you to lose weight and eat a healthy diet, to a specialist stop smoking clinic, or to a supervised exercise program.

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.

Learn more at: http://tinyurl.com/q878b7y