We all carry some degree of risk for heart attack or stroke. Understanding one’s risk factors and using them to calculate individual cardiovascular risk is an important part of preventive health care. Until you know, you can’t act.
“It is very important to identify your risk, as it is modifiable,” says Dr. Stephanie White, a cardiologist on staff at SSM St. Mary’s Health Center. “Knowing your ‘numbers,’ such as cholesterol and blood pressure—and changing them—does make a difference.”
Yet calculating risk requires looking at a number of overall health indicators and behaviors. Some can be changed through lifestyle choices or medication. Others are just part of our genetic and hereditary makeup, and can’t be modified for better or worse.
Dr. Lynne Seacord, a cardiologist with Washington University Physicians, recommends the Framingham Coronary Heart Disease Risk Score (cvdrisk.nhlbi.nih.gov/calculator.asp), which lets an individual calculate his or her risk of a heart attack or death within 10 years. The calculator accounts for age, gender, total cholesterol, HDL cholesterol (often referred to as ‘good’ cholesterol), smoking, blood pressure, and whether an individual is being treated for high blood pressure.
“Individuals with a 10-year risk of less than 10 percent are considered low-risk, 10 to 20 percent are intermediate-risk, and more than 20 percent are considered high-risk,” Seacord explains. “That is to say, high-risk individuals have a one in five chance of having a heart attack or death from a cardiac cause in the next 10 years. The big risk factor not included in the calculator is diabetes. All diabetics are considered high risk. As you know, obesity—especially truncal obesity (belly fat)—and a sedentary lifestyle also add to cardiac risk.”
White echoes Seacord’s warning regarding diabetes and adds a couple more cautionary categories: “Diabetes is considered a cardiovascular risk equivalent, meaning the risk it carries is almost as high as if you’ve had a heart attack before. Similarly, peripheral vascular disease (carotid, aortic and illiac disease) and chronic kidney disease, especially those on dialysis, can be found in this category. Family history also can increase your risk if a first-degree relative had a diagnosis of coronary artery disease at a young age—younger than 50 for men and younger than 60 for women.
Because calculating risk can be complex and require updating information regarding cholesterol levels and blood pressure, White recommends the best way to determine risk—and then plan accordingly—is through patient-physician dialog. Not only can your primary-care physician help you determine risk most accurately, but he or she can suggest actions that will help mitigate risk.
“Identifying those who are high-risk can be a wake-up call to diet and lifestyle changes that can improve risk factors,” White says. “Diet, exercise, weight loss and smoking cessation can all lead to better blood pressure, lower cholesterol and better blood sugar control that can decrease risk of developing coronary disease.”