Category: HEARTe

Risk factors are conditions which affect your risk of developing cardiovascular disease. These risk factors can be “modifiable” – because they can be changed or treated, or “non-modifiable” – because you can do nothing to change them. Throughout the modules risk factors will be described as modifiable or non modifiable.

CHSS supports the Charter for a smoke free generation in Scotland by 2034 to protect young people and support positive health choices.

A number of CVD primary prevention strategies are in place across primary care. In addition, a strategy that is used in some areas of Scotland is Keep Well, one of NHS Scotland’s key delivery vehicles for reducing health inequalities. The programme was launched in October 2006, as part of the Scottish Government’s 2005 health policy ‘Delivering for health‘.

The Keep Well vision is ‘to increase the rate of health improvement in deprived communities by enhancing primary care services to deliver anticipatory care’.

This will be achieved by:

• identifying and targeting those at particular risk of preventable serious ill-health (including those with undetected chronic disease)
• offering appropriate interventions and services to them
• providing monitoring and follow-up.

ASSIGN is a cardiovascular risk scoring tool that is used within HEARTe and across Scotland. This tool was developed in collaboration with Dundee University, Scotland in 2006.

In addition to classic risk factors and a family history of cardiovascular disease, ASSIGN includes social deprivation as a risk factor. This is the first risk calculator to utilise social deprivation and is based on a large scale study within a Scottish population. 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.

CVD refers to all the diseases of the heart and circulation, including stroke and coronary heart disease (angina and heart attack). It is the number one cause of death globally, and remains the single greatest killer in Europe, accounting for over 4.30 million deaths annually.

Coronary Heart Disease (CHD) is a preventable disease which kills around 8,000 people in Scotland each year. The disease is caused when the heart’s blood vessels, the coronary arteries, become narrowed or blocked and cannot supply enough blood to the heart. This can cause a heart attack, chest pain or angina.

CHD is a priority in Scotland, where prevalence of the associated risk factors such as smoking, poor diet and physical inactivity is high and around 7.5% of men and 4.9% of women are living with CHD. The incidence has been decreasing steadily over the last 10 years, with a reduction of 43.2% since 2002, however, it remains more prevalent in areas of high deprivation.

The Scottish Government published their strategy document Better Heart Disease and Stroke Care Action Plan in June 2009. This confirmed that heart disease would continue to be a national clinical priority for NHS Scotland.

At the end of this topic you should be able to:

• Describe and identify risk factors to developing cardiovascular disease and individuals specifically at risk
• Outline advice which should be shared with patients at risk
• Consider the need for risk assessment and tools that can facilitate this, including the role and remit of the Keep Well Programme
• Identify medicines used to reduce the risk of cardiovascular disease
• Identify self management strategies specific to primary prevention and the support that may be required