What does cardiovascular risk assessment involve?
The risk of coronary events or, more generally, cardiovascular risk, is determined on the basis of certain laboratory tests and the medical history taken by the doctor during the consultation.
What does cardiovascular risk assessment include?
The most important cardiovascular risk factors certainly relate to the patient’s personal history: in particular, older age, family history, overweight and obesity, smoking, high blood pressure, physical inactivity and diabetes play a key role. Laboratory data are added to these, mainly those included in the lipid profile. In addition, some non-invasive instrumental tests may be useful for assessing risk, such as an exercise stress test, stress scintigraphy, electrocardiogram, CT and echocardiogram.
How is the lipid profile used?
The lipid profile includes total cholesterol, LDL and HDL cholesterol and triglycerides. Triglycerides are an important lipid energy source for the body and are the form in which fats are stored in the body. The desirable values for the individual lipid profile parameters are:
- Total cholesterol < 200 mg/dl
- LDL cholesterol < 100 mg/dl*
- HDL cholesterol > 40 mg/dl
Triglycerides < 150 mg/dl
* These are “desirable” values; the target LDL cholesterol value depends on the presence of other risk factors and on the type of prevention being carried out, primary or secondary.
If one or more values fall outside these ranges, cardiovascular risk increases. Mild increases or decreases can be corrected simply by changing your lifestyle; otherwise medication may be used. Reducing the number and extent of risk factors reduces the cardiovascular risk to which the person is exposed.
What other laboratory tests are requested to assess cardiovascular risk?
The lipid profile is certainly the most important laboratory test for assessing cardiovascular risk. Recent studies suggest that other parameters may also help to assess cardiovascular risk, although there is not yet agreement on this. These parameters include homocysteine, Lp(a) and high-sensitivity C-reactive protein (hs-CRP). Homocysteine is a sulphur-containing amino acid involved in methionine metabolism; hyperhomocysteinaemia seems to be associated with a slight increase in cardiovascular risk, although treatments aimed at lowering it have no effect on risk. Lp(a) is a lipoprotein containing apolipoprotein(a) and, like LDL, has an atherogenic effect, although it does not respond to the usual strategies for lowering LDL cholesterol, such as a healthy lifestyle and lipid-lowering drugs. High-sensitivity CRP is a marker of the chronic subclinical inflammation typical of the atherosclerotic process.
How is treatment decided?
Treatment, when needed, is decided on the basis of several factors, including the results of the tests mentioned, family and personal history and lifestyle habits; it aims to control modifiable risk factors such as high cholesterol, high blood pressure and obesity.
Is there anything else I should know?
A low-fat diet and regular exercise are the first-line approach to reducing high cholesterol and high triglycerides, as well as many other major risk factors. There are also medicines – statins and fibrates – that are effective in lowering cholesterol and triglycerides respectively. Inherited dyslipidaemias may not respond to lifestyle changes and therefore require targeted drug treatment.
1. Are some people more at risk than others of having a heart attack (acute myocardial infarction)?
Yes. People who are overweight or obese, smokers, men, people with high blood pressure or diabetes, people with high cholesterol and/or high triglycerides, and people with a family history of cardiovascular disease are at greater risk.
2. Are there devices for assessing my cardiovascular risk at home?
No. Cardiovascular risk is assessed on the basis of laboratory and instrumental test results and the medical history taken by the doctor. All this requires dedicated equipment and qualified staff.