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Cardiovascular risk assessment clinic

If you are worried about your long term cardiac risk you can review the health of your heart with our leading cardiac prevention expert.

Many more people are deciding to take proactive management of their future health. Whether heart conditions run in your family or not, taking initiative to review your heart health or cardiac risk can produce some significant benefits. At the South Wales Heart Centre, we run a cardiovascular risk assessment clinic which enables patients to review the health of their heart with a leading cardiac prevention expert.


About cardiovascular disease

Cardio vascular disease (CVD), including stroke, is the biggest killer in the UK, Europe and North America.

The UK has one of the highest rates of death from CVD per head of population, accounting for 240,000 deaths per year.

Most importantly, the first clinical presentation of coronary heart disease is with a heart attack, many of which can be fatal.


Why choose us?

As the leading provider for cardiovascular disease in South Wales, you are in safe hands. We offer you access to a comprehensive risk assessment based on your individual needs. Your consultant will take a full history during your consultation which will include age, gender, ethnicity, smoking history, physical activity levels, diet and family history of premature cardiac disease or diabetes.

Other relevant history may include any cardiac symptoms (if present this may require an additional assessment), rheumatoid disease, poly cystic ovary syndrome, erectile dysfunction, significant periodontal disease.

Dependent on your needs, you may require diagnostic testing such as echocardiogram, blood pressure test, blood tests, cardiac MRI, cardiac CT, ECG or stress ECG.

Should your results highlight a specific problem, we have a variety of highly trained cardiologists with sub-specialities to meet your individual needs.


Our consultants

Our cardiovascular risk assessment clinic is supported by Professor Halcox who is an international leader in the field of preventive cardiovascular medicine and has been involved in the development of European as well as local guidelines for the prevention and treatment of cardiovascular disease.

As a general cardiologist, Professor Halcox has a wealth of experience from his NHS positions at the Morriston and Singleton Hospitals. His expertise is in the investigation and treatment of patients with coronary artery disease, high blood pressure and high cholesterol as well as advanced cardiovascular risk assessment and prevention of heart attack and stroke.


How do I book?

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

Understanding cardiovascular 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. Read on below to learn more.

Atherosclerosis

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.

Clinical presentation

Clinical symptoms of the disease develops 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.

Refining cardiovascular risk assessment

Conditions associated with increased risk of cardiovascular disease include:

  • 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.

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

 

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).

Our cardiac prevention expert