This week SIGN (Scottish Intercollegiate Guidelines Network) published Guideline No 97 - Risk estimation and prevention of Cardiovascular Disease (CVD):-
- Full Guideline (this review references this booklet)
- Patient Guideline
- Quick Reference Guide
- Costs and Resources to implement in Scotland
Coronary Heart Disease (CHD) is a disease of the heart and coronary arteries caused by a build of fatty materials in the blood vessels which supply the heart with oxygen. This can cause a heart attack, or chest pain or angina.
My risk of CVD in the next 10 years is 1 in 12.5 (8%) according to my 'ASSIGN' score (table 1). So for every 1000 persons with my CVD risk, 80 will have a CVD event in the next 10 years.
Other Factors - not accounted for by 'ASSIGN' score
- At 102cm I have borderline abdominal obesity (defined as greater or equal to 102cm waist measurement in men). (4.7 pg 15)
- waist hip ratio is 102cm/98cm = 1.04 (<0.95>
- I'm overweight BMI >25 (12st 6 pounds, height 5'7.5", BMI 27.5).
In October 2006 my blood tests were:
- 5.1 mmol/l total cholesterol (NHS normal: <=5.0)
- 3.0 mmol/l LDL 'bad' cholesterol
- 1.02 mmol/l HDL 'good' cholesterol (normal >1.03) (4.7 pg 15)
- total cholesterol/HDL cholesterol ratio = 5.0
- Blood pressure = 130 systolic/70 diastolic (normal <130/85)
- On 30th April 2007 my figure (ex Poole Hospital 110/70)
- 5.9 mmol /l glucose
- current risk of CVD is 8% - table 1
- Aspirin is of limited value or unsafe
- Statins are safe and should be taken daily after
- a baseline checkup (total cholesterol, LDL, HDL, Triglycerides, blood pressure, Creatine Kinase, liver transaminase, serum creatinine and proteinuria)
- Statin treatment targets
- 30% reduction in LDL cholesterol (from 3 to 1.9 mmol/l)
- 24% reduction in total cholesterol (from 5.1 to 3.88 mmol/l)
- reduce risk of CVD by 25% - from 1 in 12 (8%) to 1 in 17 (6%) over 10 years - table 2.
- Fibrates or Nicotinic acid treatment targets (after initial statin treatment)
- Reduce CVD risk to 5% (1 in 20) by increasing HDL cholesterol to medium levels (1.34 mmol/l) - table 3
- Reduce CVD risk to 4% (1 in 25) by increasing HDL cholesterol to high levels (1.73 mmol/l) - table 4
- Reduce CVD risk to 3% (1 in 33) by reducing systolic blood pressure from 130 to 108 mmHg by improving diet and increasing exercise - table 5
Table 5: 3% risk after treatment to give low blood pressure