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 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.

In some cases high blood pressure can be lowered by: losing some 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' for details.

Cholesterol and other lipids
In general, the higher the blood cholesterol level, the greater the risk of developing cardiovascular diseases. The risk that a high cholesterol level poses is greater if you also have other significant risk factors such as diabetes or high blood pressure. As a rule, no matter what your cholesterol level is, then 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. A high blood level of triglyceride, another type of lipid (fat), also increases the health risk.

Diabetes and kidney disease
The increased risk that these conditions 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.

Assessing (calculating) your cardiovascular health risk

A 'risk factor calculator' is commonly used by doctors and nurses to assess the cardiovascular health risk for an individual. 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. If you want to know your 'score', see your practice nurse or GP.

Who should have their cardiovascular health risk assessed?
Current UK guidelines advise that the following people should be 'screened' to assess their cardiovascular 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 55, or in a mother or sister before they were 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 you do not need to be screened. This is because you are already known to be in the high risk group.

What does the screening involve?
A doctor or nurse will do a blood test to check your cholesterol and glucose (sugar) level. Your blood pressure will be measured. Your smoking status will be recorded. A score is calculated based on these measurements 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.

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 risk factors 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. (That 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% (between 1 in 10 and 2 in 10 chance).
• low risk - if your score is less than 10% (less than a 1 in 10 chance).

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 (to lower the chance of it getting worse, or of developing a further disease).
• People with diabetes. If you have diabetes, the time that treatment is started to reduce cardiovascular risk depends on factors such as: your age, how long you have had diabetes, your blood pressure, and 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 drug treatment is usually advised along with advice to tackle any lifestyle issues. This usually means:医学 全在.线提供www.med126.com

• Drug treatment, usually with a statin drug, to lower your cholesterol level. No matter what your current cholesterol level, drug treatment is advised. The aim is to reduce the level by 25% or to get the level under 4 mmol/l - whichever is the biggest reduction. See leaflet called 'Cholesterol' for details.
• Drug treatment to lower blood pressure if your blood pressure is high. This is even if your blood pressure is just mildly high. See leaflet called 'High Blood Pressure' for details.
• A daily low dose of aspirin (75 mg daily) - depending on your age and other factors. Aspirin helps to prevent blood clots from forming on patches of atheroma. See leaflet called 'Aspirin to Prevent Blood Clots' for details.
• where relevant, to encourage you even more to tackle lifestyle risk factors. This means to:
  • stop smoking if you smoke.
  • eat a healthy diet.
  • keep your weight and waist in check.
  • take regular physical activity.
  • cut back if you drink a lot of alcohol.
  You may be offered a referred to specialist services. 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 at Prodigy - www.prodigy.nhs.uk called 'Cardiovascular Disease Risk - Assessment and Management'.

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. Drug treatment 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 in the above paragraph).

Some people with a moderate risk buy a low dose statin drug from a pharmacy to lower their cholesterol level. (Statin drugs 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 you doctor know so that it can be put on your medical record.)

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