Lifestyle

Your Practice Nurse or Health Care Assistant will calculate your health risk using your age, sex, smoking status, blood pressure, cholesterol level, etc. The score gives a fairly accurate indication of your risk of developing a cardiovascular disease over the next 10 years.

What does the risk assessment score mean?

You are given a score as a % chance. For example, if yourscore is 30% this means

that you have a 30% chance of developing a cardiovascular disease within the next 10 years. Another words, 3 in 10 people with the same score that you have will develop a cardiovascular disease within the next 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 youth odds.

You are said to have a high risk – if your score is 20% or more. That is, a 2in 10 chance or more of developing a cardiovascular disease within the next 10years.

What treatments are available to reduce the risk?

If you are at high risk

If you are at high risk of developing a cardiovascular disease then you will be given advice to tackle any lifestyle issues and drug treatment is usually advised.

• Stop smoking if you smoke
• Eat a healthy diet
• Keep your weight and waist in check
• Take regular physical activity
• Cut back if you drink a lot of alcohol
• Drug treatment, usually with a statin drug, to lower your risk.
• Drug treatment to lower blood pressure if it is high. This is even if your blood pressure is just mildly high.

What if I am at moderate or low risk?

If you are not in the high risk category, it does not mean you have no risk – just a lesser risk. Drug treatment 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 above).

Your risk factors can be split into two groups – thosewhich can be prevented or changed and those which are fixed and you cannotalter.

Fixed risk factors – ones that you cannot alter:

• A strong family history. This means a father or brother who developed heart disease or a stroke before they were 55, or in a mother or sister before they were 65.
• Being male.
• An early menopause in women.
• Age. The older you become, the more likely you are to develop these diseases.
• Ethnic group. People who live in the UK with ancestry from India, Pakistan, Bangladesh, or Sri Lanka have an increased risk.

If you have a fixed risk factor, you may want to make extra effort to tackle any lifestyle risk factors that can be changed. 

Lifestyle factors that can be prevented or changed:

• Smoking.
• Lack of physical activity (a sedentary lifestyle).
• Obesity.
• An unhealthy diet and eating too much salt.
• Excess alcohol.
• Hypertension (high blood pressure)
• High cholesterol and/or triglyceride (fats) in the blood

Note: some risk factors are more ‘risky’ than others. For example, smoking probably causes a greater risk to health than obesity. Also, risk factors interact. So, if you have two or more risk factors, your health risk is Muchmore increased than if you just have one. For example, a middle aged male smoker who does little physical activity and has a strong family history of heart dis

Lifetime smoking roughly doubles your risk of developing heart disease. The chemicals in tobacco get into the bloodstream from the lungs and damage the arteries and other parts of the body. Your risk of having a stroke and developing other diseases such as lung cancer are also increased. Stopping smoking is often the single most effective thing that a person can do to reduce their health risk. The increased risk falls rapidly after stopping smoking (although it takes a few years before the excess risk reduces completely). If you smoke and are having difficulty in stopping, then ask your practice nurse for help and advice.

People who are physically active have a lower risk of developing heart disease and diabetes compared to inactive people. To gain health benefits you should do at least 30 minutes of moderate physical activity, on most days (at least five days per week).

30 minutes in a day is probably the minimum to gain health benefits. However, you do not haveto do this all at once. For example, cycling to work and back 15 minutes eachway adds up to the total of 30 minutes.

Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. Forexample: brisk walking, jogging, swimming, cycling, etc.

On most days. You cannot ‘store up’ the benefits of physical activity. You need to do it regularly – at least 5 days a week.

If you are overweight or obese and lose weight it will reduce your risk of developing heart disease or diabetes. Even if you don’t lose all your excess weight, you will still get benefit from a small weight loss if you can keep it off.

Being overweight around your middle increases the risk even more. As a rule, a waist measurement of 102 cm or above for men (92 cm for Asian men) and 88 cm or above for women (78 cm for Asian women) is a significant health risk.

Eating healthily helps to control your weight, and lower your cholesterol level. Both of these help to reduce your health risk. Briefly, a healthy diet means:

• AT LEAST five portions of fruit and vegetables daily, ideally more, and have a variety of different types. These contain antioxidants which may help to prevent cholesterol building up in your blood vessels (see later).
• BASE YOUR MEALS ONSTARCHY FOODS such as cereals, wholegrain bread, potatoes, rice or pasta plus plenty of vegetables.
• CUT DOWN ON FAT by reducing fatty foods such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low fat, mono-,or poly-unsaturated spreads. If you eat meat it is best to eat lean meat, or poultry such as chicken.  If you do fry, choose a vegetable or olive oil.
• INCLUDE 2-3 portions offish per week. At least one of which should be ‘oily’ (such as herring, mackerel, sardines, kippers, salmon, or fresh tuna).
• LIMIT SALT to no more than 6 g a day (and less for children). See below for details. Try flavouring foods with herbs and spices instead of salt.

Adults should eat no more than 6 g salt a day (about a teaspoon of salt) as salt increases blood pressure which can lead to strokes and heart disease.  The current average daily intake of salt in the UK is 9 g per day. About three quarters of the salt we eat is already in the foods we buy. By simply checking food labels and choosing foods with lower salt options, it can make a big difference.

Also, try not to add salt to food at the table.

The recommended upper limits for alcohol are men should drink no more than 21 units per week (and no more than four units in any one day) and women should drink no more than 14 units per week (and no more than three units in any one day). One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits. Remember, alcohol contains empty calories so think about cutting back further if you are trying to lose weight.

You should have your blood pressure checked at least every 3-5 years. High blood pressure usually causes no symptoms, so you will not know if it is high unless you have it checked. However, over the years, high blood pressure may do some damage to the arteries and put a strain on your heart. In some cases, high blood pressure can be lowered by: losing some weight if you are overweight, regular physical activity, and eating healthily as described above. Medication may be advised if your blood pressure remains high.

Cholesterol and other lipids

In general, the higher the blood cholesterol level, the greater the risk of developing cardiovascular diseases (heart disease, stroke and diabetes). These are caused by a build-up of fat in the blood vessels called atheroma.  A patch of atheroma makes an artery narrower. This can reduce the blood flow through the artery. Intime, patches of atheroma can become larger and thicker. They may trigger a blood clot which blocks the artery and can cause a heart attack, angina, stoke or other problems.

As a rule, no matter what your cholesterol level is, then lowering the level reduces your risk. This is why people at high risk of developing a cardiovascular disease are offered medication to lower their risk. A high blood level of triglyceride, another type of lipid (fat), also increases the health risk.

Further help and information

• British Heart Foundation offer advice on all areas of heart disease
• Tel (Heart Help Line): 08450 708070 – Web: www.bhf.org.uk
• NHS Choices: Offer advice on healthy lifestyles, and health problems