Major risk factors for ischaemic cardio- and cerebrovascular disease:
» Diabetes mellitus.
» Central obesity: waist circumference 102 cm (men) and 88 cm (women). » Smoking.
> total cholesterol > 5.0 mmol/L, or
> LDL > 3 mmol/L, or
> HDL < 1 mmol/L in men and < 1.2 mmol/L in women.
» Family history of premature cardiovascular disease in male relatives < 55 years and in female relatives < 65 years.
» Age: men > 55 years, women > 65 years.
All persons with risk factors for ischaemic heart disease should be encouraged to make the following lifestyle changes as appropriate:
» Smoking cessation.
» Weight reduction in the overweight patients, i.e. BMI > 25 kg/m2.
» Maintain ideal weight, i.e. BMI < 25 kg/m2.
» Reduce alcohol intake to no more than 2 standard drinks/day
» Follow a prudent eating plan i.e. low saturated fat, high fibre and unrefined carbohydrates, with adequate fresh fruit and vegetables.
» Moderate aerobic exercise, e.g. 30 minutes brisk walking at least 3 times a week.
Calculation of risk of developing cardiovascular disease over 10 years (in the absence of cardiovascular disease)
To derive the absolute risk as percentage of patients who will have a myocardial infarction over 10 years, add the points for each risk category (Section A). The risk associated with the total points is then derived from Section B.
S E C T I O N A
*Type 2 diabetics >40 years, qualify for statin therapy irrespective of risk score.
S E C T I O N B
» Established atherosclerotic disease, irrespective of cholesterol or triglyceride plasma concentrations:
> ischaemic heart disease,
> peripheral vascular disease, or > atherothrombotic stroke.
» Type 2 diabetics > 40 years of age.
» Chronic kidney disease (eGFR < 60 mL/minute.)
» A risk of MI of greater than 20% in 10 years (see table above).
Such high-risk patients will benefit from lipid lowering (statin) therapy irrespective of their baseline LDL-C levels.
HMGCoA reductase inhibitors (statins) that lower LDL by at least 25%, e.g.:
When lipid-lowering drugs are used, this is always in conjunction with ongoing lifestyle modification
» Random cholesterol >7.5 mmol/L.
» Fasting (14 hours) triglycerides >10 mmol/L.