Prevention of Cardiovascular Disease
Cardiovascular disease (CVD) describes disease of the heart and blood vessels caused by the process of atherosclerosis. It is the leading cause of death in England and Wales, accounting for almost one-third of deaths. In 2010, 180,000 people died from CVD – around 80,000 of these deaths were caused by coronary heart disease and 49,000 were caused by strokes. Of the 180,000 deaths, 46,000 occurred before people were aged 75 years, and 70% of those were in men.
CVD shows strong age dependence and predominantly affects people older than 50 years. Risk factors for CVD include non-modifiable factors such as age, sex, family history of CVD, ethnic background and modifiable risk factors such as smoking, raised blood pressure and cholesterol.
Tools are available to estimate an individual’s particular risk. Currently we use QRISK2. This estimates the risk of an individual developing clinically significant cardiovascular disease over the next 10 years.
Clearly reducing this risk is beneficial. Some risk factors cannot be changed such as sex, age and ethnicity. Other factors can be addressed and thus risk reduced. These include smoking, exercise, diet and cholesterol level.
Current NICE guidance, recommends that cholesterol-lowering drugs, statins, can be used for individuals with a 10 year risk of more than 10%.
The risks of cigarette smoking are well known. Stopping smoking is the quickest way to reap big benefits in terms of preventing disease, particularly cardiovascular disease.
Please visit the Preston smoking cessation website www.greaterprestonccg.nhs.uk/giving-up-smoking for information on how to access this service, or telephone 0800 328 6297.
Lifestyle modifications can help prevent CVD.
Firstly, eat a diet in which total fat intake is 30% or less of total energy intake, saturated fats are 7% or less of total energy intake, intake of dietary cholesterol is less than 300 mg/day and where possible saturated fats are replaced by mono-unsaturated and polyunsaturated fats. Further information and advice can be found athttp://www.nhs.uk/Livewell/healthy-eating/Pages/Healthyeating.aspx. Further information and advice on healthy cooking methods can be found at NHS Choices.
Physical activity is of benefit in a multitude of ways, both physical and psychological.
Individuals at high risk of or with CVD should, each week, undertake at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous intensity aerobic activity or a mix of moderate and vigorous aerobic activity For more details, visit http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx.
Muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) are recommended
People who are unable to perform moderate-intensity physical activity because of medical conditions or personal circumstances should exercise at their maximum safe capacity.
A local exercise referral scheme is available for individuals who meet the criteria. Please visit the websitehttp://www.lancashirecare.nhs.uk/Services/Adult-Community/Healthy-Lifestyle.php and if you feel you meet the criteria, make an appointment with one of our practice nurses for referral to the scheme.
Statins for the prevention of CVD
We would normally recommend lifestyle changes as outlined above. If such modification is inappropriate or ineffective, we are pleased to offer therapy with statins. The current drug of choice as recommended by NICE is Atorvastatin 20mg for those who have a 10% or greater 10-year risk of developing CVD. The risk is estimated using the QRISK2 assessment tool. http://www.qrisk.org
Should they wish, we would offer people the opportunity to have their risk of CVD assessed again after they have tried to change their lifestyle.
The QRISK2 tool is only useful up to they age of 85. Beyond that age, statins may be of benefit to all individuals in reducing the risk of non-fatal heart attack (Myocardial infarct)
Follow-up of people started on statin treatment
It is recommended to measure the lipid profile and liver enzymes in all people who have been started on statin treatment at 3 months of treatment.
We would consider a yearly non-fasting blood test cholesterol to inform discussion if a patient felt it would be beneficial.
Side effects and complications of statins
Other drugs, some foods (for example, grapefruit juice) and some supplements may interfere with statins so please always consult the patient information leaflet, a pharmacist or prescriber for advice when starting other drugs or thinking about taking supplements.
If you are being treated with a statin, please seek medical advice if you develop muscle symptoms (pain, tenderness or weakness).