Appendix VII: Cardiovascular Risk Assessment
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
Non-laboratory Based Risk Screening
Laboratory Based Risk Screening
NON-LABORATORY BASED RISK SCREENING
BMI-based Risk Assessment
- Measure body mass index (BMI): BMI = weight (kg) / [height (m) x height (m)]
- Measure blood pressure.
LoE:IIIb1
- Calculate 10-year risk of a cardiovascular event using the BMI-based CVD risk tool below.
- Use the patient’s sex, age, BMI, systolic BP and smoking status to work out what colour block they fall into.
- Explain to the patient what his/her risk of heart attack or stroke might be over the next 10 years.
Click on image to enlarge.
- Manage the risk as recommended, see Prevention of heart disease and atherosclerosis.
Click on image to enlarge
BMI-based risk assessment
Adopted with permission from the Knowledge Translation Unit and authors of the Adult Primary Care guideline (2023). This tool is based on the WHO cardiovascular disease non-laboratory-based Southern Sub-Saharan Africa. From: HEARTS technical package for cardiovascular disease management in primary healthcare risk based CVD management. World Health Organisation, Geneva, 2020
LABORATORY BASED RISK SCREENING
Framingham Risk Score (Cholesterol-based)
- To derive the absolute risk as a percentage of patients who will have a cardiovascular event (i.e., death, myocardial infarction, or stroke) over 10 years, add the points for each risk category (Section A). The risk associated with the total points is then derived from Section B.
- Calculation of CVD risk using the table:
- A risk of MI > 20% in 10 years equates to ≥ 15 points for men, and ≥ 18 points for women. It is important to score each patient individually, as there are many combinations of risk factors that can add up to those total points.
- For example:
- A male patient > 60 yrs old with systolic BP > 140 mmHg on treatment would score:
- 11 points for his sex and age
- 4 points for his on-treatment BP
- Total: 15 points
- A male patient > 50 yrs old with systolic BP > 130 mmHg on treatment who is a smoker would score:
- 8 points for his sex and age
- 3 points for his on-treatment BP
- 4 points for his smoking status
- Total: 15 points
- A female patient > 70 yrs old with systolic BP > 160 mmHg on treatment would score:
- 11 points for her sex and age
- 7 points for her on-treatment BP
- Total: 18 points
- A male patient > 60 yrs old with systolic BP > 140 mmHg on treatment would score:
Click on image to enalrge.
Click on image to enlarge.
Framingham risk score assessment
1 BMI-based CVD risk assessment: D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008 Feb 12;117(6):743-53. https://www.ncbi.nlm.nih.gov/pubmed/18212285
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_25 October 2024
Appendix VII: Cardiovascular Risk Assessment