• Cardiovascular risk in first degree relatives of patients with premature coronary heart disease

      Dhillon, Ranjit K. (University of Chester, 2009-09-30)
      Context: In most parts of the United Kingdom current cardiac services neglect assessment and primary prevention of cardiovascular disease in first degree relatives of patients with proven premature coronary heart disease. First degree relatives are at a higher risk than the general population by virtue of shared lifestyle risk and genetic factors to index cases. Objectives: This study aimed to identify first degree relatives of patients with proven coronary heart disease and assess their cardiovascular risk, using various cardiovascular risk assessment tools. We also aimed to assess the effectiveness of cardiovascular risk reduction services on the cardiovascular risk of the individual. Design, Setting, and Participation: A qualitative study was conducted at Sandwell Hospital. 43 participants aged 18- 74years were recruited. Results: The mean age of the cohort was 42(±4). 66% were under the age of 40years. At the baseline appointment 30% of the cohort, had a systolic blood pressure greater than 140mmHg, mean 140(±14.8) mmHg and 28% had a diastolic blood pressure greater than 90mmHg, mean 94(±2.12) mmHg. 82% of south Asians had a BMI greater than 23 Kg/m2. 63% of non south Asians had a BMI greater than <25 Kg/m2. 37%. 61% of the cohort’s total cholesterol was greater than 5mmol/l, mean 7.1(±1.8) mmol/l. 64% had triglycerides greater than 2.0mmol/l, mean 2.75(±0.49) mmol/l. The high density lipoprotein for males, 11% had a level greater than less than 1.0mmol/l, mean 1.2(±0.2) mmol/l, 4% of females had a level less than 1.2mmol/l, mean 1.4(±1) mmol/l. The cardiovascular tools QRISK, ETHRISK CVD, Framingham CVD identified over 10% of the cohort as high risk at the baseline appointment, and at the review appointment there was no change using QRISK. However, ETHRISK CVD and Framingham CVD demonstrated a risk reduction in the cohort. The tools varied in their selection of high risk, moderate risk and low risk. ETHRISK CHD and Framingham CHD and BNF identified 7% as high risk. Referral to specialist services was initiated with 14% referred for investigations, 21% commenced on medication or was altered. 12% of smokers were referred to a smoking cessation services. 25% referred to weight management service. 32% were referred to Cardiologist or Lipidologist. 19% referred to exercise on prescription. Conclusions: The study identified risk factors in individuals who would not conventionally access the current National Health Service Health Checks programme and should therefore be seen as complementary to NHS Health Checks. 66% were under the age of 40years who accessed the service. This population would not be able to access the systematic Health Checks programme provided by the National Health Service. This study therefore, illustrates the benefits of providing a tailored service for young individual’s potentially high risk and susceptible to premature CVD. This service enabled first degree relatives to choose a healthier lifestyle to reduce their risk of cardiovascular event in the future.