Cardiovascular Risk Assessment
Ten-year risk calculation using SCORE and Framingham.
Areas of Expertise
Preventive Cardiology and Heart Health Screening in İzmir
Identifying and reducing risk before heart disease develops is a key part of Prof. Dr. İstemihan Tengiz's clinical approach. He offers cardiovascular risk assessment using SCORE and Framingham scores, personalised cholesterol/LDL targets and lifestyle counselling. He has contributed to community-based awareness through hypertension training for family physicians (Journal of Clinical Medicine Family Practice, 2013).
Why preventive cardiology?
Cardiovascular disease is the leading cause of death worldwide and in Turkey. Yet most of it is driven by risk factors that can be identified and modified before disease appears: high blood pressure, high cholesterol, smoking, diabetes, physical inactivity, excess weight and poor diet.
The purpose of preventive cardiology is to quantify a person's future risk while they are still symptom-free and to lower that risk with targeted measures. The difference between treating a patient who has had a heart attack and preventing that attack from ever happening is what the preventive approach delivers.
How is cardiovascular risk calculated?
Risk is not judged from a single value but by combining factors. The SCORE2 model used in European guidelines, and SCORE2-OP for those over 70, combine age, sex, smoking status, systolic blood pressure and non-HDL cholesterol to express as a percentage the probability of a fatal or non-fatal cardiovascular event over the next ten years. The Framingham score is another widely used model.
Based on the result, people are classified as low, moderate, high or very high risk. This classification is not an academic detail: it directly determines how low the cholesterol target should be, when drug therapy should begin and how often follow-up should occur. People with diabetes, chronic kidney disease or established vascular disease are counted as high risk without needing a calculation.
Cholesterol and LDL targets
LDL cholesterol is the principal driver of plaque formation in the arterial wall, and lowering it directly reduces risk. The target is not the same for everyone; it is set by risk category. A more relaxed target suffices in low-risk individuals, whereas in very high-risk patients with established vascular disease the aim is to bring LDL to considerably lower levels and to at least halve it from baseline.
Treatment rests on dietary change and statins. If the fall is insufficient, ezetimibe is added; in selected patients who still miss target, PCSK9 inhibitors come into play. Measuring lipoprotein(a) at least once is recommended where familial hypercholesterolaemia is suspected and in those with a history of early-onset heart disease.
Blood pressure, blood sugar and weight
Controlling blood pressure is one of the most effective ways to lower cardiovascular risk. The target for most adults is around 130/80 mmHg, individualised for age and comorbidity. Blood pressure should be measured at least once a year, supported by home monitoring in those at risk.
Diabetes and the preceding prediabetic phase accelerate vascular damage; they are screened for with fasting glucose and HbA1c. Waist circumference indicates risk independently of body mass index, because abdominal fat is closely linked to insulin resistance and vascular disease. Even a five to ten per cent reduction in body weight produces measurable improvement in blood pressure, blood sugar and triglycerides.
Lifestyle: the strongest and cheapest treatment
At least 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic exercise per week is recommended, plus resistance training on two days. Increasing daily step count and breaking up long periods of sitting are beneficial on their own. A Mediterranean-style diet based on olive oil, vegetables, fruit, whole grains, legumes and fish has the strongest evidence for reducing cardiovascular events.
Stopping smoking is the single intervention that reduces risk most rapidly and most substantially; electronic cigarettes are not a safe alternative. Seven to eight hours of regular sleep, investigation of sleep apnoea and management of chronic stress are also part of cardiovascular protection.
Which tests, how often?
Baseline screening in symptom-free adults covers blood pressure, lipid profile, fasting glucose, height, weight and waist circumference, and an ECG. The general approach is to repeat this every few years in people without risk factors and annually in those with them. Screening should start earlier in people with a family history of early heart disease.
Advanced tests such as exercise testing, echocardiography or coronary CT angiography are not applied to everyone; they come into play when there are symptoms, examination findings or a high calculated risk. Cardiological assessment beforehand is recommended for those taking up competitive sport and for middle-aged and older people starting an intensive exercise programme.
Family history and community awareness
Cardiovascular disease appearing in a first-degree relative before the age of 55 in men or 65 in women is an independent risk indicator. In people with such a history, screening starts earlier and targets are set more tightly. In inherited conditions such as familial hypercholesterolaemia, screening the relatives of a diagnosed patient — cascade screening — is recommended.
Preventive cardiology is practised not only in the clinic but at community level. Prof. Dr. İstemihan Tengiz has contributed to raising awareness in primary care through hypertension education programmes for family physicians and has published the results of this work (Journal of Clinical Medicine of Family Medicine, 2013).
Procedures Performed
Cholesterol Management
Individualised LDL targets and treatment follow-up.
Lifestyle Counselling
Nutrition, exercise, salt restriction and smoking cessation.
Hypertension Training for Family Physicians
Community-based awareness and education programmes.
Frequently Asked Questions
At what age should I have my first heart check?
In people without symptoms or known risk factors, blood pressure and cholesterol screening should begin in early adulthood and continue at regular intervals thereafter. Those with a family history of early heart disease, sudden death or high cholesterol need earlier and more frequent assessment.
My cholesterol is high — should I start medication straight away?
The decision depends not on the cholesterol value alone but on your total cardiovascular risk. In a low-risk person, diet and exercise can be optimised first and the situation reassessed after a few months. In those with vascular disease, diabetes or a very high LDL, drug therapy is started without delay.
Are statins harmful?
Statins are among the most extensively studied drug classes, and when used for the right indication the benefit far outweighs the risk. The most commonly reported side effect is muscle ache; genuine statin-related muscle problems are less frequent than assumed and are usually resolved by adjusting the dose or switching to a different statin. Treatment is continued safely with monitoring of liver enzymes and symptoms.
Who should have an exercise test?
Exercise testing is useful in people with symptoms such as chest pain or exertional breathlessness who have an intermediate probability of coronary disease. It is not recommended as routine screening in people with no symptoms and no risk factors, because false-positive results can lead to unnecessary further testing.
What are the symptoms of a heart attack?
The most typical symptom is pressure, tightness or heaviness in the centre of the chest, which may radiate to the arm, jaw, back or stomach. It can be accompanied by cold sweating, nausea and breathlessness. Symptoms may be more subtle in women, older people and those with diabetes, appearing only as fatigue, indigestion or breathlessness. Call emergency services immediately whenever a heart attack is suspected.
There is heart disease in my family — what should I do?
Tell your physician about any cardiovascular disease in first-degree relatives before the age of 55 in men or 65 in women. In that case screening begins at a younger age, lipid and blood pressure targets are set more tightly, and where appropriate family members are also assessed for inherited high cholesterol.
Content reviewed by Prof. Dr. İstemihan Tengiz. Last reviewed:
The information on this page is for general information only and is not a substitute for medical advice. Please consult your physician about your symptoms.