If you already have a cardiovascular disease or diabetes then your risk does not need to be assessed because you are already in the high-risk group.
Who should have their cardiovascular health risk assessed?
- All adults aged 40 or more.
- Adults of any age who have:
- A strong family history of an early cardiovascular disease. This means if you have a parent, sister or brother who developed heart disease or a stroke before they were aged 60.
- A first-degree relative (parent, brother, sister, child) with a serious hereditary lipid disorder. For example, familial hypercholesterolaemia (FH) or familial combined hyperlipidaemia. This condition may affect as many as 1 in 250 people in the UK, but only a small proportion of people are diagnosed early. This condition greatly increases your risk of having an early heart attack.
What does the screening involve?
A doctor or nurse will ask if you have any current lifestyle risk factors that increase your risk of developing a cardiovascular disease. These include smoking, obesity, a poor diet, lack of physical activity and drinking a lot of alcohol.
You will then have a blood test to check your blood cholesterol and sugar (glucose) level. Your blood pressure will be measured.
A score is calculated based on several of these risk factors, your age and sex. An adjustment to the score is made for certain other risk factors such as strong family history and ethnic origin.
There are many different calculators. The Framingham calculator has been used for a long time but many health professionals are moving over to QRISK®3 risk assessment. This is more accurate and takes into account many other factors such as whether you have a condition called atrial fibrillation, or kidney disease.
What does the assessment score mean?
You are given a score as a % chance. So, for example, if your score is 30% this means that you have a 30% chance of developing a cardiovascular disease within the following 10 years. This is the same as saying a 30 in 100 chance (or a 3 in 10 chance). So in this example, 3 in 10 people with the same risk factors that you have will develop a cardiovascular disease within the following 10 years.
Note: the score cannot say if you will be one of the three. It cannot predict what will happen to each individual person. It just gives you the odds. You are said to have a:
- 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 following 10 years.
- Moderate risk - if your score is 10-20%. This is between a 1 in 10 and 2 in 10 chance.
- Low risk - if your score is less than 10%. This is less than a 1 in 10 chance.
Who should be treated to reduce their cardiovascular health risk?
Treatment to reduce the risk of developing a cardiovascular disease is usually offered to people with a moderate or high risk. That is:
- People with a risk assessment score of 10% or more. That is, if you have a 1 in 10 chance or more of developing a cardiovascular disease within the following 10 years.
- People with an existing cardiovascular disease (to lower the chance of it getting worse, or of developing a further disease).
- People with diabetes. If you have diabetes, the time that treatment is started to reduce cardiovascular risk depends on factors such as:
- Your age.
- How long you have had diabetes.
- Your blood pressure.
- Whether you have any complications of diabetes.
- Whether you have type 1 or type 2 diabetes. Almost all people with type 1 diabetes, and most with type 2, are at high risk of cardiovascular disease.
- People with certain kidney disorders.
What if I am at low risk?
If you are at low risk, it does not mean you have no risk - just a lesser risk. Medication 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).
Some people with a low risk buy a low-dose statin drug from a pharmacy to lower their cholesterol level. Statin medicines are available on prescription and funded by the NHS if your risk is moderate or high. However, you need to buy them if your risk is in the low category. If you do buy a statin and take it regularly, it is best to let your doctor know so that it can be put on your medical record.
Further reading and references
Cardiovascular disease: risk assessment and reduction, including lipid modification; NICE Guidance (July 2014 - last updated 2016)
2016 European Guidelines on cardiovascular disease prevention in clinical practice; European Society of Cardiology (2016)
Risk estimation and the prevention of cardiovascular disease; Scottish Intercollegiate Guidelines Network - SIGN (2017)
Familial hypercholesterolaemia: identification and management; NICE Guideline (2008, last updated October 2019)
Estruch R, Ros E, Salas-Salvado J, et al; Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25.
CVD risk assessment and management; NICE CKS, March 2019 (UK access only)