For each patient attending an NHS Health Check, the date of attendance in the financial year was taken as the index date. This index date was used to identify the most relevant risk factor measurements for each attendee. Not all risk factor and clinical measurements were recorded on this index date. Therefore the risk factor and clinical measurements from other dates have been used in some cases. Risk factor and clinical measurements were selected for analysis if they occurred on the index date; but if no information was recorded on the index date, the information recorded up to 365 days before the check was used as the 2nd priority or up to 90 days after the check as the 3rd priority. For family history of CVD, the order for the priority for analysis is; if they occurred on the index date (priority); if no information was recorded on the index date the information recorded before the check (2nd priority) or after the check (3rd priority) was selected. A full list of clinical codes (Read v2 and CTV3) used to define each risk factor and the range for plausible values are published.
For most risk factors (alcohol use, smoking status, physical activity, blood pressure, cholesterol, possible diabetes) attendees were categorised as either being at high risk, not being at high risk or as having missing information.
For body mass index (BMI), attendees were categorised as either being obese, being overweight, being not overweight or as having missing information.
For CVD risk in the next 10 years, attendees were categorised in 4 categories: score of 20 per cent or more (high risk of developing CVD), score between 10 and 19 per cent, score below 10 per cent (low risk) or as having missing information.
For family history of CVD, attendees were categorised as either being at risk or not being at risk.
||Source of information
||Risk threshold cut point
||Score from FAST and/or AUDIT and/or AUDIT-C test
||Higher risk is full AUDIT score 8 or more
||Clinical code for smoking status
||High risk if current smoker
||Recorded score from GPPAQ test
||Higher risk if “moderately inactive” or “inactive”
|Body mass index
||Recorded BMI value. Calculated BMI if BMI not recorded but values for height and weight available
Overweight if BMI ≥ 25 and <30kg/m2
Obese if BMI ≥ 30kg/m2
||Systolic and diastolic blood pressure recordings
||Higher risk if systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg
||Value of total cholesterol and value of cholesterol ratio. Ratio= total cholesterol
||Higher risk if total cholesterol >5mmol/L or Ratio > 4
|CVD risk score
||QRISK / QRISK2 score or Framingham score if QRISK and QRISK2 unavailable
||Higher risk if risk of CVD event in the next 10 years is 20% or more
||Value of HbA1c or of Fasting Plasma Glucose (FPG)
||Higher risk if HbA1C ≥ 48 mmol/mol or FPG ≥ 7
|Family history of CVD
||Clinical code recorded at any point
||Higher risk if CVD event before 60 years old in a first degree relative
To avoid potential disclosure all counts are rounded up to the nearest 5. Counts of zero remain as zero.
AUDIT: Alcohol use disorders identification test
BMI: Body mass index
CVD: Cardiovascular disease
FAST: Fast alcohol screening test
FPG: Fasting Plasma Glucose
GPPAQ: General practice physical activity questionnaire
HbA1c: Haemoglobin A1c
HDL: High-density lipoproteins
IMD: Index of Multiple Deprivation
LSOA: Lower Super Output Area
UTLA: Upper Tier Local Authority