Coronary Disease

Most doctors will agree that your future health is predicated upon a combination of your genetic makeup as well as the risks you are exposed to over the years. Whilst risk factors such as family history are impossible to change, a detailed appreciation of your genetic predisposition can be a valuable indicator of cardiovascular risk and the subsequent development of heart disease or stroke. As well as non-modifiable risk factors like family history, there are a number of modifiable risk factors such as smoking, diabetes, and hypertension, which can promote the development of cardiovascular disease. Many of these diseases can go undiagnosed for many years before we are able to influence their effects on your body, by which time it is often too late to offer the greatest advantages of treating these conditions. Screening is increasingly being used to allow early diagnosis of these risk factors, in order to allow early intervention. In addition, earlier diagnosis of cardiovascular disease itself, can also avoid the development of heart attack or stroke.

How Can We Predict Your Individual Risk?

Various predictive tools have been developed, which are able to “calculate” your individual cardiovascular risk, and the subsequent probability of developing heart disease or stroke. One of the best calculators is the United Kingdom (UK) based QRISK2 score. This cardiovascular risk score was developed by doctors and clinical researchers from data submitted by General Practitioners across the UK and is updated every year based upon new population statistics. The calculator can be found at https://qrisk.org/2016/, and requires knowledge of simple array of clinical information to calculate risk. Here is a simple example of the data which can be produced: A 35-year-old Caucasian male of average UK height (175cm; 5’9”) and weight (84kg; 13 stones approx.) who smokes 10-19 cigarettes per day has a risk of developing a heart attack or stroke estimated at 2.2%. Most doctors would suggest that this is not high, although we would still strongly advise giving up smoking. If we were to add only one of the following risk factors to this man, his risk changes considerably: Add Family history*: Risk 4.5% (twice as high) Add High blood pressure: Risk 5.7% (more than 2.5 times higher) Add Type 2 diabetes: Risk 7.1% (more than 3 times higher) *Family history of angina or heart attack in a first degree relative before they were 60 years old. In this example, genetic predisposition doubles the risk of heart attack or stroke in this man over the next 10 years. The presence of high blood pressure, or diabetes, increases his risk from 2.5 to 3 times higher than if these problems were not present. If you are unfortunate enough to be found to suffer from either of these two conditions, then it is probably not a bad idea to know about it, because you can then make the changes required to counteract their effects on your body over time. Many people, however, are blissfully unaware of the presence of these and other risk factors until they have been present for some time. “It is often during this latent undiagnosed period that much damage occurs” If any doubt exists about the importance of knowing about the presence of these risk factors, let us take the previous example of the 35-year-old male smoker. If all three factors of family history, hypertension and diabetes exist in this man then the risk of suffering a heart attack or stroke by the time he is 45 years old is 34%, or a 1 in 3 chance! A 35-year-old Caucasian male of average UK height (175cm; 5’9”) and weight (84kg; 13 stones approx.) who smokes 10-19 cigarettes per day with a family history of heart disease and high blood pressure, and Type 2 diabetes: Risk 34% or a 1 in 3 chance! *Family history of angina or heart attack in a first degree relative before they were 60 years old. “If these risks go unnoticed, then no one can doubt that opportunities to influence cardiovascular risk will be missed”

Key Message

For you to change your cardiovascular risk, you need to know a great deal more about your body and your health than you might think. A few simple blood tests and a thorough clinical examination is a powerful way to understand your cardiovascular risk. In addition, modern non-invasive technologies can now allow accurate screening of patients for important heart problems, where early treatment can make a real difference to your health.

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Sun 28 February 2016

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