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Expert: Alison Warren, Primary Care Cardiovascular Society secretary, consultant pharmacist for cardiology, Sussex Clinical Commissioning Groups and University Hospitals Sussex

There are numerous risk factors that increase the chance of a person developing cardiovascular disease (CVD). Some risk factors such as age, gender, ethnicity and family history cannot be modified, but there are many modifiable ones including weight, diet, exercise, smoking status, blood pressure, cholesterol, and diabetes that can be addressed.

Identifying someone at increased risk allows them to take preventative measures such as changing their lifestyle or taking medicines. This is called primary prevention of CVD.

Validated clinical tools are available to help assess an individual’s risk – NICE recommends the QRISK tool, and the ASSIGN risk score is recommended by SIGN and used in Scotland.

These web-based tools give an estimate of the percentage risk of developing CVD (coronary heart disease, stroke and transient ischaemic attack) over the next 10 years.

Much of the information required to undertake a CVD risk assessment can be obtained using a structured consultation in a community pharmacy. One piece of the jigsaw that may be missing is the lipid profile, although the patient may be able to share their results of blood tests with the pharmacy via the NHS app, or the pharmacy may have the facility to undertake point-of-care testing.

A 10-year CVD risk score of 10% or more is considered high risk and, in addition to lifestyle, is the threshold for considering offering lipid-lowering treatment to reduce CVD risk. It is important to remember that this is an estimate – in certain groups of people (but not limited to these groups), risk may be underestimated.

This includes people treated for HIV, those already taking medicines to treat CVD risk factors, individuals who have recently stopped smoking, people taking medicines that can cause abnormal lipid levels, and people with autoimmune or other systemic inflammatory disorders. Furthermore, even if the score is less than 10%, some people may wish to consider lipid-lowering therapy and this remains an option.

The first-line lipid-lowering therapy is usually atorvastatin 20mg once a day with the aim of reducing LDL-cholesterol (or non-HDL-cholesterol) by at least 40%.