Earlier in the week Bert attended the GP practice to see Nurse Claire about his flu vaccination. The nurse suggested that Bert comes back for a BP and health check, as he rarely attends the surgery.
Below are his non-fasted results from the cardiovascular health check. (Some areas may have locally specific referral criteria which differs from the national guidelines. For example, some areas use a fasting blood sample during an initial consultation.)
A tool that is used across Scotland and within HEART-e is ASSIGN a cardiovascular risk score. This was developed in collaboration with Dundee University, Scotland in 2006.
ASSIGN includes social deprivation for the first time, and family history of cardiovascular disease, with the classic risk factors. It identifies people free of cardiovascular disease most likely to develop it over ten years. ‘High risk’ (score 20 or more) implies risk-lowering medication and/or other medical help. ASSIGN is the cardiovascular risk score chosen for use by SIGN (Scottish Intercollegiate Guidelines Network) and Scottish Government Health Directorates.
The nurse calculates Bert’s ASSIGN score. Look at Bert’s results above and work out the results for yourself. Remember, he is 66, his postcode is QQ1 1QQ and he has a family history of CVD. Calculate Bert’s ASSIGN score.
Results:
- BP 158/94 – This blood pressure measurement was elevated and required rechecking, in the first instance. If this level of blood pressure is measured on a follow up consultation then further investigation and medication management is required, given Bert’s other risk factors.
- Pulse 76 regular – This pulse is normal. It important to consider the rate and rhythm when checking a pulse. An irregular, unusually fast or unusually slow pulse should always be further investigated by taking a clinical history and recording an ECG.
- Total cholesterol 7.9mmol/l – A cholesterol of >7.5mmol/l could be an indicator of familial hypercholesterolemia (FH) using Simon Broome’s diagnostic criteria. Further investigation (fasting full lipid profile) including a more detailed history and family history would be required to exclude FH.
- HDL 1.1mmol/l – HDL is a predictor of cardiovascular risk. HDL is not improved with statin medication but increasing exercise can increase HDL cholesterol (the good cholesterol).
- Glucose (random) 6.8mmol/l – A random blood glucose level of ≥6.1mmol/l requires follow up with a fasting sample for evidence of impaired glucose regulation or new diabetes
- BMI 31 – Individuals with a body mass index (BMI)>30 have a 40-fold increased risk of developing diabetes and a two to three-fold increased risk of CHD and stroke compared to individuals with a normal BMI (≤25). (Ref: SIGN 149).
- Waist circumference 111cm – Central obesity, as measured by waist circumference, is a better predictor of cardiovascular risk than BMI. Central obesity is present if the waist circumference is ≥102 cm in men (≥90 cm in Asian men) and ≥88 cm in women (≥80 cm in Asian women). (Ref: SIGN 149).
Pulse point
Health Scotland have issued the postcode QQ1 1QQ to be used for persons with no fixed address. It has been incorporated into the lookup postcode for SIMD 2012, with a readout of a middle value for the most deprived fifth of the population. When entered into ASSIGN the value is 48.8. This postcode will be utilised for all HEARTe cases where ASSIGN is required to be calculated.
Page last reviewed: 28 May 2020
