3: Preventative cardiology

Published on 02/03/2015 by admin

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Last modified 22/04/2025

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TOPIC 3 Preventative cardiology

Topic Contents

Smoking 19
Obesity and diet 19

World Health Organization (WHO)/National Institute of Health (NIH) Classification 19
Waist circumference 19
World Health Organization (WHO)/National Heart Lung and Blood Institute (NHLBI) Classification 20
Hypertension 20

European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Classification, 2007 20
Recommended daily salt intake 20
Hypercholesterolaemia 20

ESC Guidelines 20
Diabetes and metabolic syndrome 21

ESC Guidelines on treatment targets in type 2 diabetes 21
International Diabetes Federation (IDF) definition of metabolic syndrome 21
Family history of heart disease 21
Homocysteine 21
Renal impairment 22
High-sensitivity C-reactive protein (hsCRP) 22
Cumulative risk scores 22

Smoking

Smoking independently increases cardiovascular risk 2–4-fold compared with non-smokers and combines with other risk factors to greatly increase cardiovascular risk.

Relative risk reduction of smoking cessation falls to match that of a life-long non-smoker after 10–15 years.

Obesity and diet

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World Health Organization (WHO)/National Institute of Health (NIH) Classification

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Waist circumference

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World Health Organization (WHO)/National Heart Lung and Blood Institute (NHLBI) Classification

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Hypertension

European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Classification, 2007

See Table 3.1.

Table 3.1 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Classification

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Recommended daily salt intake

< 3.8 g/day (equivalent to sodium intake of 65 mmol/day)

Hypercholesterolaemia

ESC Guidelines

See Table 3.2.

Table 3.2 European Society of Cardiology (ESC) Classification of Hypercholesterolaemia

Category Total cholesterol (mmol/L) LDL (mmol/L)
General population <5 (190 mg/dl) < 3 (115 mg/dl)
High risk < 4 (155 mg/dl) < 2 (80 mg/dl)

Diabetes and metabolic syndrome

ESC Guidelines on treatment targets in type 2 diabetes

See Table 3.3.

Table 3.3 European Society of Cardiology (ESC) Guidelines on treatment targets in type 2 diabetes

Category Unit Target
HbA1c HbA1c (%) ≤ 6.5
Plasma glucose Fasting/pre-prandial mmol/L (mg/dl) < 6.0 (110)
Blood pressure mmHg ≤ 130/80
Total cholesterol mmol/L (mg/dl) < 4 (155)
LDL cholesterol mmol/L (mg/dl) < 2 80

International Diabetes Federation (IDF) definition of metabolic syndrome

Metabolic syndrome is a combination of cardiovascular risk factors in individuals with obesity or insulin resistance (specifically, central obesity, hypertension, low HDL cholesterol, raised triglycerides and hyperglycaemia).

Must have:

1. Central obesity (defined by ethnic-specific waist circumference criteria ≥ 94 cm in Europoid men, ≥ 80 cm in Europoid women).

Plus two of the following:

1. Elevated triglycerides ≥ 1.7 mmol/L (≥ 150 mg/dl) or on treatment for lipid abnormality.
2. Low HDL cholesterol < 1.03 mmol/L (40 mg/dl) in men, < 1.29 mmol/L (50 mg/dl) in women or on treatment for lipid abnormality.
3. Hypertension. Systolic > 130 mmHg and/or diastolic >85 mmHg or diagnosed hypertension.
4. Impaired fasting glycaemia. Fasting plasma glucose ≥ 5.6 mm/L (100 mg/dl) or diagnosed type 2 diabetes.

Family history of heart disease

Cardiovascular risk increases 1.5–1.7 fold with an affected first-degree male relative aged < 55 years or female relative aged < 65 years.

Homocysteine

Increased plasma concentrations of this sulphur-containing amino acid are associated with increased cardiovascular risk.

Normal plasma homocysteine concentration = 8–15 μmol/L
Moderate hyperhomocysteinaemia = 16–30 μmol/L
Intermediate hyperhomocysteinaemia = 31–100 μmol/L
Severe hyperhomocysteinaemia = >100 μmol/L

A 5 μmol/L rise in plasma homocysteine can increase cardiovascular risk by 20–30%.

Renal impairment

Cardiovascular risk increases 20–30-fold with the diagnosis of end-stage renal failure.

High-sensitivity C-reactive protein (hsCRP)

The acute phase, C-reactive protein can function as a marker for generalized inflammation which is a risk factor for cardiovascular disease. See Table 3.4.

Table 3.4 High-sensitivity C-reactive protein (hsCRP) and risk

hsCRP level Risk
< 1.0 mg/L Low
1.0–2.9 mg/dl Intermediate
>3.0 mg/L High

Cumulative risk scores

These integrate sex, age, smoking history, blood pressure and cholesterol profile to produce an estimated individual absolute 10-year risk of a cardiovascular event (myocardial infarction, stroke, angina and associated cardiovascular mortality) (Figure 3.1).

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Figure 3.1 Cardiovascular risk prediction charts for non-diabetic women (A) and non-diabetic men (B).

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