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South Wales Heart Centre
In Association with Spire Cardiff Hospital, South Wales

South Wales Private Specialists in Heart Care

Cardiovascular risk assessment clinic

  • Cardiovascular disease (CVD), including heart attack and stroke, is the biggest killer in the UK, Europe and North America.

    UK Statistics

    The UK has one of the highest rates of death from CVD per head of population, accounting for 240,000 deaths per year. In real terms this means (accounting for 1 in 3 of all deaths, are as a result of CVD approximately1/2 of these are due to heart attacks and 1/4 from stroke)

    Most importantly, as often as not, the first clinical presentation of coronary heart disease is with a heart attack many of which are fatal!

    Our Cardiovascular risk assessment clinic provides:

    Patient history will be taken during the initial consultation, this will include the following

    • Age
    • Gender
    • Ethnicity
    • Smoking history
    • Physical activity levels
    • Diet (fruit/veg/fish)
    • Family history of premature CVD, DM

    Other relevant medical history may be required

    • Symptoms of CVD (if present, separate assessment required)
    • Rheumatoid Disease
    • PCOS
    • Erectile Dysfunction
    • Significant periodontal disease 

    A physical / clinical examination may be taken during your consultation, this will allow your specialist to give youan accurate diagnosis.

    • Height, Weight, BMI, Waist Circumference
    • Seated BP
    • Full CV examination (significant signs of CVD may require separate assessment)
    • Blood tests 
    • Calculate renal function
    • Urinalysis including microlbuminuria)
    • ECG

    Understanding Arterial Disease

    To prevent and treat vascular disease we need to understand the mechanisms of the disease process, in particular the influence of risk factors that promote these changes.

    A combination of non-invasive diagnostic tests combined with Serological Assessment in selected individuals will provide a more accurate assessment and classification of risk than conventional risk assessment.

    For further information or to arrange an appointment with our cardiac risk assessment specialist Professor Julian Halcox  call 029 2073 6011.


    Almost all heart attacks and most strokes are due to a disease process call atherosclerosis, commonly referred to as “hardening of the arteries”. This disease is characterised by the accumulation of fatty, cholesterol-rich, deposits called “plaques” in the walls of the arteries. Although this disease process is widespread, these plaques tend to develop more commonly at certain sites in the arterial system, in particular the coronary arteries of the heart and the carotid arteries in the neck. Other arteries, including those to the legs and kidneys, are also frequently affected.

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  • Clinical Presentation

    Clinical symptoms of disease develop in 2 distinct ways:
    Firstly, and most dramatically, the plaque may split open (plaque rupture) exposing the contents to the circulating blood. This causes the rapid formation of a blood clot (thrombosis) which can block the vessel leading to an abrupt cessation of blood flow and death of the tissues downstream. This is how almost all acute heart attacks occur. Secondly, as the plaque enlarges over time, it may narrow the vessel and start to limit the flow of blood. When this reaches a critical level insufficient delivery of oxygen and energy and reduced rates of clearance of the accumulated waste products leads to problems (known as Ischaemia). This is particularly relevant in a highly demanding organ like the heart. Patients typically experience pain, pressure or tightness in their chest (Angina) which tends to occur when the heart is working harder during exercise or emotional stress.

    The disease processes of atherosclerosis progress at different rates in different people, but in general tend to be driven by exposure to several risk factors:

    Major risk factors for arterial disease include:

    • Increasing Age
    • Male Gender
    • High Cholesterol
    • High Blood Pressure
    • Smoking
    • Diabetes mellitus

    These risk factors appear to work together to promote the development of disease to an extent that is greater than the sum of their parts. Importantly, risk factors tend to cluster together; i.e. someone with type 2 diabetes is more likely also to have high blood pressure and a bad cholesterol profile.

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  • Refining CVD Risk Assessment:

    Conditions associated with increased risk of CVD

    • Chronic Kidney Disease
    • Obesity
    • High Triglycerides
    • Impaired Glucose Regulation (Impaired fasting glucose/Impaired glucose tolerance)
    • Family History of Premature CVD (in first degree relative before retirement age)
    • South Asian Ethnicity
    • Erectile Dysfunction
    • Periodontal Disease
    • Polycystic Ovarian Syndrome
    • Gout
    • Inflammatory Diseases (Rheumatoid Arthritis, SLE, COPD)

    Therefore more representative risk assessment tools are required to estimate CVD risk, particularly in the working age population, and in those with these clinical identifiers of additional CVD risk.

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  • Advanced Risk Assessment

    Further information that adds value to the results of conventional risk factor assessment can be obtained by the measurement of other factors that promote the disease or reflect the activity or extent of the disease process itself. These parameters are collectively termed “Biomarkers”. These parameters are not routinely offered in the NHS for the prevention of CVD, but are offered by CVD prevention specialists in the private sector in the UK and Western Europe and more widely in the USA.

    Biomarkers of disease can be divided into 2 categories; those that can be measured in the blood and direct assessment of the arterial system for signs of disease.

    Blood tests to calculate CVD Risk

    hsCRP -  High Sensitivity C-Reactive Protein is a general marker of
    inflammation that has been shown to help identify an increased risk of CV events over and above conventional risk factors in many clinical studies.

    Lipoprotein subfractions - Very detailed assessment of the size and density of the particles that carry cholesterol in the bloodstream. This can provide insights into their potential future contribution to the development of atherosclerotic plaque

    Apolipoproteins A and B -  Provide a more detailed assessment of the lipid profile that together with the routine lipid profile allows estimation of particle size. It is quicker, easier and cheaper to measure Apolipoproteins than lipoprotein subfractions, although slightly less accurate.

    Lipoprotein (a) -  A marker of risk of accelerated atherosclerosis and acute events, particularly in high risk families and when other risk factors are present

    Lp-PLA2 - Lipoprotein-Associated Phospholipase A2 is an enzyme that influences the biology of LDL particles promoting inflammation in atherosclerotic plaque. A marker of “plaque instability” increased LpPLA2 levels are associated with an increased risk of heart attack and stroke. (Ref  Davidson et al AJC 2008)

    Insulin - Fasting insulin levels together with fasting glucose allows more detailed estimation of glucose regulation and diabetes risk.

    BNP -  Brain Natriuretic Peptide is a marker of cardiac “stress”. Used as a diagnostic test for heart failure, higher BNP levels may also help identify those at increased cardiac risk even in the absence of heart failure

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  • Diagnostic tests

    Almost all heart attacks and most strokes occur in people with diseased arteries. Not surprisingly, the more diseased the arteries the greater the risk! Several non-invasive techniques have been developed provide insight into the state of the arteries.

    Coronary CT Scanning
    This technique is able to identify calcium deposits in the coronary arteries. In most people this is due to atherosclerosis. The amount of calcium present in the artery correlates very closely with the amount of atherosclerotic plaque, and a standardised scoring system for quantification of calcification has been developed.

    The technique is quick and easy. The main consideration is the exposure to a small radiation dose, making it a less appropriate screening test for low-risk individuals.

    Carotid Ultrasound
    The large arteries that supply blood to the brain (carotid arteries) which run along each side of the front of the neck are particularly susceptible to the atherosclerotic disease process. As they are fairly superficial structures it is usually very easy to image these vessels in great detail using high-resolution ultrasound. Thickening of the vessel wall (known as intima-media thickening [IMT]) and development of plaque can be identified at an early stage and these changes correlate well with the changes seen in the walls of the coronary arteries. Several studies have shown that carotid IMT and plaque can help better predict heart attack and stroke than risk factors alone (Ref Lorenz et al Systematic review Circulation 2007) and major guidelines support the use of carotid ultrasound for risk prediction (ref ESC prevention guidelines 2007, American Society of Echocardiography Guidelines 2008). 

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Professor Julian Halcox

CT scan image axial of the heart 

© Spire Healthcare Group plc (2016)