Cardiac Risk Assessment

Age

You are a woman over 55 years old, OR you’ve passed menopause or had your ovaries removed and are not taking estrogen, OR you are a man over 45 years old

Family History

Your father or brother under age 55, or your mother or sister under age 65, has had a heart attack, stroke or bypass surgery.

Smoking

You smoke OR you are exposed to second-hand smoke most every day.

Blood Pressure

Your blood pressure is higher than 120/80, OR you’ve been told that your blood pressure is too high, OR you don’t know what your blood pressure is.
Blood Pressure_______________

Physical Activity

You get less than a total of 30 minutes of physical activity on most days.

Diabetes

You have diabetes, a fasting blood sugar of 126 mg/dl or higher, OR you have been told you have pre-diabetes, a fasting blood sugar of >100 mg/dl.
Blood Sugar:_________________

Blood Cholesterol Levels

(LIPIDS)
Your HDL (High Density Lipo-protein or “good” cholesterol) is less than 50mg/dl or your LDL (Low Density Lipo-protein or “bad” cholesterol) is greater than 130 and you have been identified with having risk factor for heart disease. (An HDL of 60 is considered protective)

Obesity

Check your Body Mass Index (BMI). A score of 25-29 indicates you are overweight, 30 or greater, obese.
BMI:____________

Stress

You have a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.

Medical History

You have coronary heart disease, OR you’ve had a heart attack.

Metabolic Syndrome

Having at least three of a cluster of symptoms that are listed below places you at risk.

• Central obesity as measured by waist circumference:
  (Women > 35” waist / Men > 40” waist)
  Your waist measurement _______________inches
  (Waist-to-hip ratio greater than .08 is a predictor of high triglycerides and low HDL levels)
• High blood sugar
• High triglycerides, 150mg/dl or higher
• Low HDL (<50mg/dl in women, <40mg/dl in men)
• High Blood Pressure

Excess Alcohol

A woman should limit her alcohol intake to an occasional drink or two, no more than 2oz. of alcohol per day. (e.g. a glass of wine, one beer or one cocktail)

Previous Diagnosis

You’ve been told that you have Carotid Artery Disease, or you’ve had a Stroke or TIA, OR you have a disease of the leg arteries, a high red blood cell count or sickle cell anemia.

Women Only

Post Menoposal

BY 7 OR MORE YEARS
You have had a hysterectomy and have had your ovaries removed or you have completed menopause.

Birth Control Pills

Birth control pills combined with regular exposure to cigarette smoke, greatly increases risk of heart attack and stroke, especially after age 35.