Cardiovascular Risk Assessment and Screening

Dr Jagathesan has been actively involved in Cardiovascular Risk Asessment and Cardiac Screening for many years. He regularly assesses individuals for the DVLA, EASA (pilots), MSA (motor sports), Insurance companies, Sporting individuals and Army recruits.

Who should have their cardiovascular risk assessed?

UK guidelines recommend that all people aged 40 or more should have a routine cardiovascular risk assessment. Adults of any age who have a strong family history of an early cardiovascular disease or those who have a first-degree relative with a serious hereditary lipid/cholesterol disorder are also recommended to undergo a cardiac health risk assessment.

This is usually performed by your GP and is based on an assessment of risk factors including smoking, weight, diet, physical activity, alcohol consumption. A blood test to check your blood cholesterol and glucose (sugar) level should be performed and your blood pressure will be measured. A score is then calculated based on several of these risk factors including your age and sex.

There are many different calculators. The Framingham calculator has been used for a long time but many health professionals are moving over to QRISK®2. The QRISK®2 calculator can be found online at www.qrisk.org

What does the assessment score mean?

• High risk – if your score is 20% or more. This 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%. This is between a 1 in 10 and 2 in 10 chance. This should be re-assessed every year.
• Low risk – if your score is less than 10%. This is less than a 1 in 10 chance. This should be re-assessed every 5 years.

If you are at high risk

If you are at high risk of developing a cardiovascular disease then treatment with medicines is usually advised along with advice to tackle any lifestyle issues. This usually means:

• Treatment with medication to lower your cholesterol level, usually with a statin medicine. No matter what your current cholesterol level, treatment with medication is advised.
• Treatment with medication to lower blood pressure if your blood pressure is high. This is even if your blood pressure is just mildly high.
• Where relevant, to encourage you 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.
  Reduce alcohol consumption.

Further specialist cardiac assessment may be considered in this group to quantify short term risk and this will usually include an ECG, echocardiogram and an exercise stress test.

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).

Further specialist cardiac assessment may be considered particularly in the moderate risk group and specialist coronary calcium scoring has become a useful tool in determining whether patients with moderate risk should be investigated and treated in a similar fashion to high risk patients.

Cardiac Screening in the Young

The European Society of Cardiology (ESC 2005) and International Olympic Committee (IOC) recommend cardiac screening for any young person taking part in competitive sport. Screening for cardiac disease is also strongly recommended for individuals with a family history of sudden death in a relative under the age of 35 years of age.

Screening in this group involves performing an ECG and Echocardiogram