Lets consider John’s cardiac risk factors

John’s risk factors:

Diet
Fats: There is more evidence about the role of fat in risk modification than of other dietary factors. Reduction of fat, in particular of saturated fat is one of the pillars of dietary advice to prevent CVD.
Salts: All individuals should aim to consume less than 6 g of salt per day.
Fruit and vegetables: A diet high in fruit and vegetables tends to be low in fat. An increase in fruit and vegetable consumption should be encouraged (at least 5 portions is the current recommendation).

Physical activity
Adults should aim to be active daily. This should include moderate intensity physical activity in bouts of 10 minutes or more. 30 minutes of activity, on at least 5 days a week is the current Scottish Government recommendation. All adults should minimise the amount of time spent being sedentary for extended periods.

• Moderate intensity activity causes the person to be warmer, breathe harder and make the heart beat faster but the person should still be able to hold a conversation. For example – brisk walking.

Stress
During cardiovascular assessment it is helpful to identify anxiety and / or depression using tools such as PHQ9, HADS or Core10. If score results suggest anxiety or depression then referral to appropriate services should be offered.

Harmful stress is associated with cardiovascular disease, and in addition those in poorer socioeconomic groups are at higher risk of developing cardiovascular disease and dying prematurely.

Weight management
People 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 cardiovascular disease compared to individuals with a normal BMI of ≤25. Central obesity (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 (≥80cm in Asian women).

Although smoking cessation results in considerable improvements in health, it is often accompanied by weight gain of 4-5kg over the first year of quitting. Health risks from weight gain are less than continuing to smoke. Priority is to stop smoking and address weight gain once quit and encouraging healthy eating, activity and stop smoking medicines.

Family History
Our risk for developing heart disease increases if you have a relative who developed heart disease or stroke at an early age (before 60 years old). If your parents developed cardiovascular disease later in life, it may be age-related rather than genetic.

Gender
Your gender is significant. A man is at greater risk of heart disease than a pre-menopausal woman, but once past the menopause, a woman’s risk is similar to a man’s. The risk of stroke is similar for men and women.

Blood pressure
Blood pressure is recorded as two numbers, with a ratio like this: 132/76 mmHg. The top number (systolic blood pressure), which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats. The lower number (diastolic blood pressure), measures the pressure in the arteries between the heartbeats when the heart muscle is resting and refilling with blood. High blood pressure is defined as greater than or equal to 140/90. Many people have undiagnosed high blood pressure for years. If left untreated, it can lead to left ventricular hypertrophy, coronary heart disease, heart attack or stroke.

The threshold that blood pressure is treated is dependent on a number of factors such as co-morbidities, age and 10 year cardiovascular risk calculation. Please refer to the latest guidance from the British & Irish Hypertension Society.

Smoking
Smoking is the most preventable risk factor and smokers have more than twice the risk of developing cardiovascular disease. There are many strategies in NHS Scotland to support people to stop smoking such as:

• Your local pharmacies
• Your GP and practice nurse
• NHS stop smoking service
• NHS Inform

These may vary from area to area.

Cholesterol
Cholesterol is a fatty substance (lipid), which is essential to keep the body healthy. Cholesterol is produced naturally within the body – mainly in the liver. Excess saturated fat in the diet increases blood cholesterol. Normal level is below 5mmol/l

LDL (low-density lipoprotein) is known as “bad cholesterol“. It carries cholesterol from your liver to the tissues around your body. The recommended LDL level is below 3.0mmol/l

HDL (high-density lipoprotein) is known as “good cholesterol” because it carries surplus cholesterol from the tissues back to your liver to be recycled or excreted. The recommended HDL level is above 1.0mmol/l (men) and above 1.2mmol/l (women).