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Your Heart Risk Assessment

  

Are You At Risk?

Everyone runs the risk of getting heart disease. We know that all human beings develop some degree of atherosclerosis (build-up of cholesterol plaque) in their heart arteries over the course of their lives and as a result are at risk for heart attacks because of this build-up.  This level of risk differs from one person to the next, based on the number of risk factors. Some of these are things we cannot control – such as family history of heart disease or genetic predisposition.

However, most risk factors can be controlled – such as cholesterol levels, smoking, blood pressure, diet and activity levels – through lifestyle changes or, if necessary, treatment with medications under the care of your physician.  By taking control of your heart health, you can greatly lower your risk of getting heart disease!
The Heart Institute of the Cascades | Heart Attack Risk Assessment
So, where to start?  The first step is to understand the most common risk factors known to be associated with heart disease, so that you can adjust your behavior to improve your chances of keeping or improving your heart health. The next step is to assess your current risk level using the risk prediction score (risk calculator) available below. This risk level allows you and your physician to develop a personalized action plan to lower your risk.

Read on to learn about heart disease risk factors.

Heart Disease Risk Factors

Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Other factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven't yet been precisely determined. They're called contributing risk factors.

Some risk factors can be modified, treated or controlled, and some can't. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the greater your risk. For example, everyone with total cholesterol greater than 240 mg/dL is considered high-risk, but a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 245 mg/dL.

Major Risk Factors You Can Modify, Treat or Control by Changing Your Lifestyle or Taking Medicine

Tobacco smoke: Smokers' risk of developing coronary heart disease is 2–4 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease; smokers have about twice the risk of nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes or those who chew tobacco seem to have a higher risk of death from coronary heart disease (and possibly stroke) as well. Exposure to other people's smoke (second hand smoke) increases the risk of heart disease even for nonsmokers.

High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. Here’s the lowdown on where those numbers should be:

Total Cholesterol: Less than 200 mg/dL

LDL (bad) Cholesterol:
  • If you're at low risk for heart disease: At least less than 190 mg/dL and ideally less than 160 mg/dL
  • If you're at moderate risk for heart disease: At least less than 160 mg/dL and ideally less than 130 mg/dL
  • If you're at moderate to high risk for heart disease: At least less than 130 mg/dL and ideally less than 100 mg/dL
  • If you're at high risk for heart disease (including those with existing heart or vascular disease, severe kidney disease, and/or diabetes): At least less than 100mg/dL and ideally less than 70 mg/dL
HDL (good) Cholesterol: At least 40 mg/dL for men and 50 mg/dL for women

Triglycerides: At least less than 150 mg/dL

High blood pressure: High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. This stiffening of the heart muscle is not normal, and causes the heart to not work properly.  It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.

Physical inactivity: An inactive lifestyle is a risk factor for coronary heart disease. Inactive is generally considered when someone sits in chair more than walking or engaging in regular exercise or other physical activity. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease. The more vigorous the activity, the greater your benefits. However, even moderate-intensity activities help if done regularly and long term. Physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.

Obesity and overweight: People who have excess body fat — especially at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even as few as 10 pounds, you can lower your heart disease risk.

Diabetes mellitus: Diabetes significantly increases your risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. At least 65% of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. Persons who are obese or overweight should lose weight to keep blood sugar in control.

What other factors contribute to heart disease risk?

Stress: Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

Alcohol: Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine or 12 fl oz of beer. It's not recommended that non-drinkers start using alcohol or that drinkers increase the amount they drink.

Diet and Nutrition:  A healthy diet is one of the best weapons you have to fight cardiovascular disease. The food you eat (and the amount) can affect other controllable risk factors: cholesterol, blood pressure, diabetes and overweight. Choose nutrient-rich foods — which have vitamins, minerals, fiber and other nutrients but are lower in calories — over nutrient-poor foods. A diet rich in vegetables, fruits, whole-grain and high-fiber foods, fish, lean protein and fat-free or low-fat dairy products is the key. And to maintain a healthy weight, coordinate your diet with your physical activity level so you're using up as many calories as you take in.

Framingham Heart Study Prediction Score

In 1948, the Framingham Heart Study embarked on an attempt to identify factors that contribute to cardiovascular disease by following its development over a long period of time in a large group of participants (in Framingham, Massachusetts) who had not yet developed symptoms of cardiovascular disease or suffered a heart attack or stroke.

In 1991, the current Framingham coronary prediction algorithm was introduced, which attempts to estimate the risk of coronary heart disease that may manifest as chest pain due to compromised blood flow in the heart’s arteries, heart attack, or death from coronary artery disease.  The risk of developing such complications can be approximated in men and women by assessing age, blood cholesterol (LDL-cholesterol and HDL-cholesterol), blood pressure, and smoking status.

Importantly, the Framingham Heart Study prediction score has some limitations:
  • The risk score is only appropriate for individuals without vascular disease (heart attack, stroke, aortic aneurysm), diabetes mellitus, or end-stage kidney disease
  • The risk score attempts to assess the risk of coronary heart disease.  It may not assess the risk of other forms of heart or vascular disease
  • The Framingham Heart Study is based on a study of nearly all Caucasian individuals.  It’s applicability to non-Caucasian populations may be more limited
  • The risk score estimates the 10-year risk of coronary heart disease and may not adequately assess the long-term or lifetime risk of coronary heart disease, particularly in young individuals
  • The presence of any risk factor for coronary heart disease requires attention, because even a single risk factor may confer higher risk
 
 

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