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CARDIOVASCULAR DISEASES RISK

ASSESSMENT & PREVENTION
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References
 World Health Organization. Prevention of cardiovascular
diseases: guidelines for assessment and management of
cardiovascular risk, 2007.
 World Health Organization. Package of essential Non
Communicable Diseases Interventions for primary health care
in low resource settings, 2010.
 World Health Organization. Global recommendations on
physical activity for health, 2010.
 World Health Organization. Prevention and control of Non
Communicable Diseases: Guidelines for primary health care in
low resource settings, 2012.
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Learning Objectives
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Cardiovascular Diseases
 Coronary heart disease
 Cerebrovascular diseases
 Peripheral vascular diseases.
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Risk Factors
 Non-modifiable risk factors: increased age, male sex, family
history of cardiovascular diseases and ethnic background.
 Modifiable risk factors: dyslipidemia, hypertension, smoking,
diabetes mellitus, obesity, and sedentary lifestyle.
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Cardiovascular Disease Risk Assessment

 The World Health Organization (WHO) and International
Society of Hypertension (ISH) developed the WHO/ISH risk
prediction charts to assess the estimated cardiovascular risks in
individuals who did not yet develop clinical cardiovascular
diseases.
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Step 1
 Presence or absence of diabetes mellitus. This is defined as someone
taking insulin or oral hypoglycemic drugs, or with a fasting plasma
glucose concentration above 7.0 mmol/l (126 mg/dl) or postprandial
plasma glucose. concentration above 11.0 mmol/l (200 mg/l) on two
separate occasions.
 Gender
 Smoker or non-smoker. All current smokers and those who quit
smoking less than 1 year before the assessment are considered
smokers for this assessment.
 Age (if age is 50-59 years select 50, if 60-69 years select 60 etc)
 Systolic blood pressure (the mean of two readings on each of two
occasions).
 Total blood cholesterol (if in mg/dl divide by 38 to convert to
mmol/l).
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Step 2- Add Risk

 already on antihypertensive therapy;
 premature menopause;
 approaching the next age category or systolic blood pressure category;
 obesity (including central obesity);
 sedentary lifestyle;
 family history of premature coronary heart disease (CHD) or stroke in first degree
relative (male < 55 years, female < 65 years);
 raised triglyceride level (>2.0 mmol/l or 180 mg/dl);
 low HDL (high density lipoprotein) cholesterol level (< 1 mmol/l or 40mg/dl in
males, < 1.3 mmol/l or 50 mg/dl in females);
 raised levels of C-reactive protein, fibrinogen, homocysteine, apolipoprotein B or
Lp(a), or fasting glycaemia, or impaired glucose tolerance;
 microalbuminuria (increases the 5-year risk of diabetics by about 5%);
 raised pulse rate.
 socioeconomic deprivation
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PRIMARY PREVENTION OF
CARDIOVASCULAR DISEASES
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Dietary Changes
 Reduce total fat and saturated fat intake.
o Total fat intake should be reduced to about 30% of calories, saturated fat
to less than 10% of calories, trans-fatty acids intake should be reduced as
much as possible or eliminated and most dietary fat should be
polyunsaturated (up to 10% of calories) or monounsaturated (10–15% of
calories).
 Reduce daily salt intake by at least one third and, if possible, to
<5 g per day.
 Eat at least 400 g a day of a range of fruits and vegetables as
well as whole grains and pulses.
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Physical Activity
 Perform at least 30 minutes of moderate physical aerobic
activity per day for at least 5 days per week.
 Perform 75 minutes of vigorous intensity aerobic activity per
day for at least three days per week or a mix of moderate and
vigorous activity.
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Additional Advice
 All individuals who are overweight or obese should be
encouraged to lose weight through a combination of a
reduced-energy diet (dietary advice) and increased physical
activity.
 Men should not regularly drink more than 2 cups of alcohol per
day and women should not drink more than 1 cup of alcohol
per day.
 All smokers should be counseled to stop smoking.
 Nicotine replacement therapy can be offered as needed.
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CVR <10%
Prevention of Smoking Hypertension Lipid Antiplatelets
CVD diseases Cessation Lowering
medications
At low risk. Smoking If persistent Should be The harm
Conservative cessation blood pressure advised to caused by
management counseling ≥140/90 mmHg follow a aspirin
focusing on & < 160/ 100 lipid- treatment
lifestyle mm Hg should lowering diet outweighs
interventions. continue lifestyle the benefits.
Strategies to Aspirin
lower BP . should not be
Assess BP and given to
total individuals in
cardiovascular this low-risk
risk reassessed category.
every 2–5 years.
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10≤CVR<20
Prevention of Smoking Hypertension Lipid Antiplatelets
CVD diseases Cessation Lowering
medications
At moderate Smoking If persistent Should be The harm
risk of fatal or cessation blood pressure advised to caused by
non-fatal counseling ≥140/90 mmHg follow a aspirin
vascular and < 160 / 100 lipid- treatment
events. mmHg should lowering outweighs
Monitor risk continue lifestyle diet the benefits.
profile every strategies to Aspirin
6–12 months. lower BP and should not be
have their BP given to
and total individuals in
cardiovascular this risk
risk reassessed category.
annually.
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20≤CVR<30
Prevention of Smoking Hypertension Lipid Antiplatelets
CVD diseases Cessation Lowering
medications
At high risk of Nicotine If persistent blood Adults >40 The harm
fatal or non- replacement pressure ≥140/90 years with caused by
fatal vascular therapy mmHg and < 160 high serum aspirin
events. and/or /100 mmHg who Cholesterol treatment
Monitor risk Medications are unable to (>190mg/dl) outweighs the
profile every should be lower and/or LDL benefits.
3–6 months offered to BP through cholesterol Aspirin should
motivated lifestyle strategies >115 mg/dl, probably not
smokers who with professional despite a lipid- be given to
fail to quit assistance within lowering diet, individuals in
with 4–6 months should be this risk
counseling. should be given statin. category.
considered for
treatment with
medications.
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CVR≥30
Prevention of Smoking Hypertension Lipid Antiplatelets
CVD diseases Cessatio Lowering
n medications
At very high Nicotine Individuals with Individuals in Individuals in
risk of fatal or replaceme persistent blood this risk this risk
non-fatal nt therapy pressure category category
vascular and/or ≥130/80 mmHg and should be should be
events. Medicatio < 160/ 100 mmHg advised to given low-dose
Monitor risk ns should should be follow a lipid- aspirin.
profile every be offered considered for lowering diet
3–6 months to treatment with and given a
motivated medications. statin.
smokers
who fail to
quit with
counseling
.