Steps to estimating 5-year combined cardiovascular risk using risk charts

1.  Is the individual assumed clinically to be at high risk?

Individuals who have the following conditions:

·  Existing CVD: angina, MI, angioplasty (PCI), coronary artery bypass grafting (CABG), transient ischaemic attack (TIA), ischaemic stroke, peripheral vascular disease (PVD)

·  Some genetic lipid disorders: familial hypercholesterolaemia (FH), familial defective ApoB (FDB), familial combined dyslipidaemia (FCH)

·  Diabetes with overt nephropathy (albumin:creatinine ratio ≥30 mg/mmol OR urinary albumin ≥200 mg/L)

·  Diabetes with other renal disease causing renal impairment (eGFR≥60 ml/min/1.73m2)

are assumed to be clinically high risk i.e. > 20% risk therefore do not need to be risk assessed. However, it is important to document their risk level in the Practice Management System and assess their risk factors as part of their management plan.

2.  If the individual is not assumed clinically high, then use the risk charts:

·  Choose the appropriate male/female chart

·  Choose the appropriate diabetes/no diabetes column

·  Choose the appropriate smoker/non-smoker column

·  Choose the appropriate TC:HDL ratio column along the bottom

·  Then find the appropriate age box

Within the appropriate age box, find the correct blood pressure row using the systolic blood pressure.

People who fall exactly on a threshold between cells are placed in the cell indicating higher risk

Take the colour of the final square and using the colour key below the chart, identify the risk level indicated by this colour.

3.  Do you need to add 5% to their risk?

The following group of people require 5% to be added to their risk.

·  Family history of premature coronary heart disease or ischaemic stroke in a first-degree relative (father or brother <55 years, mother or sister <65 years)

·  Māori, Pacific peoples or peoples from the Indian subcontinent

·  Diabetes with microalbuminuria

·  Diabetes for ≥10 years

·  Diabetes with HbA1c consistently ≥64mmol/mol (8%)

Note: the 5% adjustment is made ONCE ONLY for people with more than one criterion.

4.  Lastly, does the individual have a single isolated elevated risk factor?

·  TC ≥8 mmol/L

·  TC:HDL ratio ≥8

·  BP consistently ≥170/100

Lipid and BP-lowering treatment is usually recommended for individuals with single isolated elevated risk factors irrespective of their combined CV risk level.

For people outside the age boxes:

·  < 35 years - calculate as if 35 years - result is an approximation but can be useful.

·  75 years - calculate as if 70 years - result is an approximation but can be useful. Clinical judgment should take into account: likely risks and benefits of treatment, life expectancy and comorbidities and personal values.

·  For diabetics aged 20 – 34 years, an alternative risk-calculation tool based on the UKPDS can be used. See www.dtu.ox.ac.uk