Heart Health 101

What Your Cardiovascular Risk Really Means and How You Can Change It

Your heart is an incredible machine. It beats 100,000 times a day, every day, pumping blood through 60,000 miles of vessels without you ever having to think about it. But like any machine, it works best when it’s looked after - and it often gives no warning signs when things begin to go wrong.

That’s why understanding your cardiovascular risk is one of the most powerful steps you can take to protect your long-term health.

Think of it as your heart’s personal “weather forecast.” If you know a storm is brewing, you can prepare for it. And if the skies are clear, you can keep doing the right things to stay well.

What Is Cardiovascular Risk?

Your cardiovascular (CVD) risk estimates your chance of developing heart disease, stroke, or circulation problems over the next 10 years. It’s not a diagnosis - it’s a prediction based on factors known to influence heart health, including:

• Age & sex

• Smoking status

• Blood pressure

• Weight & BMI

• Cholesterol levels

• Diabetes status

• Family history

• Ethnicity

• Medical conditions such as kidney disease or inflammatory disorders

All of these factors can be measured in a routine health assessment and combined to produce a personalised CVD risk score.

How Do We Measure Cardiovascular Risk?

1. QRISK: The Standard NHS Tool

QRISK is widely used in UK primary care. It incorporates a range of demographic factors, medical history, blood pressure, and cholesterol levels to calculate your 10-year CVD risk.

Interpretation:

• QRISK <5%: Low risk

• QRISK 5 -10%: Moderate risk

• QRISK >10%: Higher risk - lifestyle changes and often medication recommended

QRISK was developed using millions of UK primary care records and has been validated across multiple cohorts (Hippisley-Cox J & Coupland C. BMJ. 2017;357:j2099)

2. New Blood Tests That Add Valuable Insight

Traditional cholesterol measurements (LDL, HDL, total cholesterol) are helpful when incorporated in QRISK calculations but don’t always show the full picture. Several advanced biomarkers are now recognised by major cardiology guidelines as risk-enhancing factors.

ApolipoproteinB (ApoB)

ApoB counts the total number of atherogenic lipoprotein particles (LDL, VLDL, IDL, Lp(a)). The higher the particle number the higher the higher risk, even if LDL-C appears normal. ApoB is more strongly associated with cardiovascular events than LDL cholesterol (Sniderman AD et al. JAMA. 2021;325(18):1804–1816)

Lipoprotein(a) (Lp(a))

Lp(a) is genetically determined and does not respond to lifestyle changes. High levels significantly increase risk of early heart disease, independent of LDL. This means an Elevated Lp(a) can increase risk even in people with otherwise low-risk profiles (Tsimikas S et al. Eur Heart J. 2023;44(33):2865–2899)

hs-CRP (high-sensitivity C-reactive protein)

hs-CRP measures inflammation which we now know is a key driver of plaque formation and rupture. An elevated hs-CRP predicts heart attack and stroke independently of cholesterol (Ridker PM et al. N Engl J Med. 2008;359:2195–2207). There is emerging evidence that reducing inflammation may lower cardiovascular risk (e.g., JUPITER trial).

NT-proBNP

NT-proBNP is. marker of cardiac wall stress. It is more commonly used in heart failure but has been shown to be useful in predicting cardiovascular risk even in people without symptoms (McKie PM et al. J Am Coll Cardiol. 2010;55(19):2140–2147)

3. Cardiac Calcium Scoring (CAC): Detecting Early Heart Disease

A coronary artery calcium CT scan detects calcium deposits in the heart arteries, this could indicate underlying plaque and therefore increased CVD risk. These scans are among the strongest predictors of future heart attack risk, outperforming cholesterol alone (Budoff MJ et al. MESA study. JACC. 2018;72(4):434–447) 

CT scans use X-rays to image the coronary arteries. As excess X-rays can cause harm they should only be done when the benefit outweighs this. 

What YOU Can Do to Lower Your Risk

1. Move More (≥150 minutes/week)

Exercise improves blood pressure, cholesterol, insulin sensitivity, body composition, and inflammation. This kind of physical activity can reduce cardiovascular mortality by up to 20–30% (Lear SA et al. Lancet. 2017;390:2643–2654)

2. Eat a Heart-Friendly Diet

Changing to a healthy diet can improve your CVD risk. The PREDIMED randomized controlled trial showed a ~30% reduction in heart attack and stroke among high-risk individuals following a Mediterranean pattern supplemented with olive oil or nuts (Estruch R et al. N Engl J Med. 2018;378:25)

3. Stop Smoking

Quitting smoking rapidly lowers your cardiovascular risk. The risk of heart disease has been shown to drop by ~50% within 1–2 years after quitting (U.S. Surgeon General Report. 2020.)

4. Stop or only drink Alcohol in Moderation

Excess alcohol increases blood pressure, atrial fibrillation risk, and weight (Roerecke M et al. Lancet. 2017;390:1015–1025)

5. Manage Stress

We know that chronic stress can influence CVD risk through increasing blood pressure, inflammation, and sympathetic nervous activity. Stress reduction interventions have been shown to lower CVD risk markers (Steptoe A & Kivimäki M. Nat Rev Cardiol. 2012;9:360–370)

6. Maintain a Healthy Weight

Even modest weight loss improves multiple risk factors with 5–10% weight loss improving blood pressure, glucose, and lipid profile (Look AHEAD Research Group. N Engl J Med. 2013;369:145–154) 

How WE (the Clinicians) Can support you Lower Your Risk

1. Cholesterol Management

Statins can reduce LDL cholesterol and stabilise plaque in patients with elevated CVD risk. They have been shown to reduce major cardiovascular events by 25–30% per mmol/L LDL reduction (Cholesterol Treatment Trialists’ (CTT) Collaboration. Lancet. 2010;376:1670–1681)

2. Blood Pressure Management

Sometimes lifestyle changes alone fail to reduce blood pressure enough to reduce CVD risk. Lowering systolic blood pressure with medication significantly reduces stroke and heart failure risk. Research suggests that for each 10 mmHg reduction in systolic BP reduces major CV events by ~20% (Ettehad D et al. Lancet. 2016;387:957–967).

3. Diabetes and Pre-Diabetes Management

Good glucose control and early lifestyle intervention protect long-term heart health. We know that successful interventions in patients with pre-diabetes can reduce progression to diabetes by 58% (Diabetes Prevention Program Research Group. N Engl J Med. 2002;346:393–403)

4. Specialist Referral

Cardiovascular risk assessments can identify early heart disease or significantly elevated risk, leading to advanced further evaluation and if required specialist intervention. 

Why This Matters - Even If You Feel “Totally Fine”

High blood pressure, high cholesterol, inflammation, and early plaque are often completely silent. This means that the majority of first cardiovascular events occur in previously undiagnosed individuals (Yusuf S et al. Lancet. 2004;364:937–952). That’s why identifying risk early is so powerful it gives you a chance to intervene before disease develops.

Take Charge of Your Heart Health

Understanding your cardiovascular risk gives you the power to shape your future. From lifestyle changes to advanced blood tests and cardiac imaging, there are many ways to protect your heart and your long-term wellbeing.

If you would like a health check to get your own personalised your risk score or explore more advanced heart screening, our team is here to guide you.