Cardio Vascular Diseases - Screening, Diagnosis, Treatment and Prevention
What is Cardiovascular Disease?
Cardiovascular disease (CVD) is the term used to cover all diseases that affect the heart and circulatory system, including coronary heart disease, heart attack, angina, stroke, Deep Vein thrombosis and peripheral arterial diseases.
The common factor with these conditions is the build-up of atheroma – small fatty lumps that develop on the walls of the body's arteries (blood vessels), causing them to narrow and thus making it harder for the artery to carry blood and oxygen to the heart.
Cardiovascular disease is the most common cause of death in the UK accounting for around a third of all deaths. Despite the best efforts from health authorities to tackle cardiovascular disease, it continues to affect and claim the lives of thousands of British men and women each year. Over 140,000 people died from heart disease and stroke in the UK every year.
Health checks for cardiovascular disease, known as vascular health checks, play a vital role in helping to predict and prevent the development of heart disease and stroke. Through these preventative screening tests, doctors are able to identify patients who are at high risk of vascular disease and provide support and advice to help them reduce or manage that risk.
Who should have their cardiovascular health risk assessed?
UK guidelines recommend that all adults aged 40 and over should undergo a routine cardiovascular risk assessment. They are also recommended for adults of any age who have:
A strong family history of early cardiovascular disease, e.g. if you have a father or brother who developed heart disease or had a stroke before the age of 55, or a mother or sister who developed cardiovascular events before they were aged 65.
A parent, brother, sister or child (i.e. first-degree relative) with a serious hereditary lipid disorder, e.g. familial hypercholesterolaemia or familial combined hyperlipidaemia.
People who fall under these two categories are at high risk of developing cardiovascular disease.
How does the Cardiovascular screening process work?
Screening for the cardiovascular disease usually starts with a doctor or nurse asking you questions about your current lifestyle habits to see if there are any factors that put you at greater risk of developing cardiovascular disease. These risk factors include smoking, excess alcohol consumption, lack of physical activity and/or a poor diet.
The next stage involves a blood test to check your blood cholesterol and glucose (sugar) levels. Your blood pressure will also be measured.#
Imaging Tests for Vascular Disease
Cardiovascular ultrasound is the imaging modality of choice to demonstrate any signs of cardiac or vascular disease. Cardiovascular ultrasound is performed my specialists' sonographers or Cardiologist in the NHS or private sector.
Carotid Duplex Imaging
This type of ultrasound visualizes the carotid arteries and blood flow velocities. This test is used in the diagnosis of carotid artery disease that can lead to strokes. Carotid artery ultrasound is offered by the NHS and private ultrasound clinics in London.
This exam utilizes both ultrasound and EKG, sometimes monitoring with exercise to evaluate the cardiac function during exercise and at rest. This test can evaluate if there is a lack of blood flow to the heart muscle during exercise. It also provides a complete evaluation of the heart, valves and cardiac function through the use of 2-D and M-mode imaging with Doppler and colour-flow ultrasound. You can find more information and book your echocardiography ultrasound in London.
A complete ultrasound study of the upper and lower extremities to evaluate extensive arterial occlusive disease. We can also evaluate for aneurysm or pseudoaneurysm, and we can evaluate bypass grafts of the lower extremities.
Is treatment necessary for people at moderate or low risk?
Drug treatment is not usually prescribed for people who have a moderate or low risk of cardiovascular disease. However, those who are not in the high-risk category may still be advised to reduce whatever risk they do have further by making relevant changes to their lifestyle.
If you have a moderate risk you may be recommended a low-dose statin drug to help lower your cholesterol level. Statins are a class of drugs that reduce the amount of 'bad cholesterol' (low-density lipoprotein or LDL) your body makes. High levels of 'bad cholesterol' in your blood can increase your risk of developing cardiovascular disease.
High-dose statins are available on prescription, while low-dose statins can be bought over the counter at pharmacies.
What treatments are available for people at high risk?
Drug treatment is usually recommended for those who are at high risk of developing cardiovascular disease. This usually involves:
Medication to lower your blood pressure if it is high, or even slightly high.
Drug treatment to lower your cholesterol level. This is advised no matter what your current cholesterol level is.
Advice is also given to help tackle any lifestyle issues you may have that increase your cardiovascular risk. For example, if you smoke and/or drink a lot of alcohol, you will be encouraged to quit smoking and reduce your alcohol consumption.
You will also be told to:
Eat a healthy, nutritious diet
Exercise on a regular basis
Keep an eye on your weight and waist size
*Note; your doctor may decide that you need more specialist help. For example, they may refer you to a dietician to help you to lose weight and eat more healthily, or to a specialist smoker's clinic to help you give up smoking.
What does the Cardiovascular assessment score mean?
Your cardiovascular risk score is given as a percentage over a 10-year period. For example, a 40% score means that you have a 40%, or 4 in 10 chance of developing a cardiovascular disease within the next 10 years.
Scores are split into three groups:
20% or more – this means that you have a High Risk of developing a cardiovascular disease within the next 10 years
10% - 20% - Moderate Risk
Less than 10% - Low Risk
People who are classed as having a high risk of cardiovascular disease are usually offered treatment to reduce their risk. In addition to having a risk assessment score of 20% or more, you are also said to have a high risk if you have diabetes or certain kidney disorders.
*Note; if you are diabetic, the commencing of treatment to reduce your cardiovascular risk depends on factors such as your age, your blood pressure, the length of time you have had diabetes, and whether you suffer from any diabetes-related complications.
What tools are used to calculate the risk assessment score?
One of the most widely used tools is the Framingham Cardiovascular Risk Calculator, which uses recent data from the Framingham Heart Study to estimate 10-year risk for hard coronary heart disease outcomes. It is designed to estimate risk in adults aged 20 and older who do not have heart disease or diabetes.
However, many health professionals are beginning to use the QRISKŪ2 calculator, an innovative and more accurate cardiovascular disease risk calculator that takes into account many other factors such as whether you have a condition called atrial fibrillation (abnormal heart rhythm), or kidney disease.
Your risk assessment score will then be calculated based on several of these risk factors, and also taking into account your age, sex, family history and ethnic origin.