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

Mental health issues

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).

Diabetes

Diabetes increases your risk of developing cardiovascular disease. Both type 1 and type 2 diabetes can lead to serious health issues and share the same risk factors as cardiovascular disease. In addition people with impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT) have an increased risk of developing Type 2 diabetes. If they do not make lifestyle modifications, they will likely develop diabetes. Both IFG and IGT are reversible. If the affected person loses weight, maintains a healthy diet and increases his or her physical activity, he or she may be able to prevent progression to diabetes.

Alcohol

Drinking too much alcohol can raise your blood pressure and, as a result, increase your cardiovascular risk. The FAST tool can be used to identify if someone’s drinking habits may be harmful to their health. A female should not exceed 14 units of alcohol per week and a male should not exceed 21 units per week. This should be spread over the course of a week with at least 2 alcohol free days during this time.

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. 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 Smokeline (0800 84 84 84) – the national free stop smoking help line.

• Smokeline (0800 84 84 84) – the national free stop smoking help line.
• Your local pharmacies
• Your GP and practice nurse
• NHS stop smoking service

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).

Modifiable risk factors

Remember to assess what stage of change someone is at during a consultation. Lifestyle modification to reduce risk from modifiable risk factors is effective if you use a motivational interview technique. As a health professional it is easy to think that it is obvious what the person has to do – but it is our role to facilitate the consultation, encouraging progression to the next stage of change (unless they are ready to make a change) by providing the information to enable the patient to consider the options.