What's Your Risk of Heart Disease?
The NCEP has a simple three-step tool for estimating your risk of developing heart disease.
Count your major risk factors
The top four major risk factors for heart disease (according to the American Heart Association) are cigarette smoking, high blood pressure, diabetes, and high cholesterol. You should know that they add up exponentially, meaning that two risk factors would increase your risk of contracting cardiovascular disease by much more than the amounts of each factor added together.
Risk factors for heart disease were first studied in Framingham, Massachusetts, just outside of Boston. Several generations of families there have shared their personal lifestyle and health information with scientists for over fifty years in what has come to be known as the Framingham Heart Study. This ongoing study identified the risk factors that people who succumbed to cardiovascular disease were likely to share.
How probable is it that you will suffer a heart attack if you have even one of these four major risk factors? According to a study analyzing data from thousands of individuals who were followed over a period of several decades, 80 to 90 percent of those diagnosed with heart disease and over 95 percent of those who died from the disease had at least one of the four major risk factors. Some risk factors are uncontrollable, such as age, gender, and family history, but there are also some you can control - for example, smoking, a sedentary lifestyle, obesity, and high blood cholesterol. What is important to understand is that the higher your LDL level and the more risk factors (other than LDL) that you have, the greater your risk of contracting heart or vessel disease.
Major risk factors
---------- Cigarette smoking
----------
High blood pressure (> or = 140/90 mm Hg or on blood pressure medication)
----------
HDL cholesterol (< 40 mg/dL): if HDL is > or = 60 mg/dL, subtract one risk factor point from your total count)
---------- Family history of early heart disease (in a father or brother < 55 years old; in a mother or sister < 65 years old)
---------- Age (men > or = 45; women > or = 55)
My total major risk factor count is ----------
Source: Adapted from the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. "Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
If you have more than two major risk factors, take the framingham ten-year risk assessment
If your major risk factor count totals 2 or more, the NCEP recommends that you proceed to calculate your ten-year risk assessment utilizing the Framingham method of scoring. This is a simple tool for calculating your risk of having a heart attack or stroke over the next 10 years, based on the Framingham Heart Study.
Framingham 10-year risk assessment
The 10-year risk assessment tool is designed for adults who have not been diagnosed with heart disease or diabetes.
10-Year Risk Calculator for Men
1. What is your age? 2. What is your HDL cholesterol (mg/dL)?
| Age |
Points |
|
HDL |
Points |
| 20-34 |
-9 |
|
> or = 60 |
-1 |
| 35-39 |
-4 |
|
50-59 |
0 |
| 40-44 |
0 |
|
40-49 |
1 |
| 45-49 |
3 |
|
< 40 |
2 |
| 50-54 |
6 |
|
|
|
| 55-59 |
8 |
|
|
|
| 60-64 |
10 |
|
|
|
| 65-69 |
11 |
|
|
|
| 70-74 |
12 |
|
|
|
| 75-79 |
13 |
|
|
|
3. What is your total cholesterol (mg/dL)?
| |
Points |
| Total Cholesterol |
|
|
|
|
|
| |
Age 20-39 |
Age 40-49 |
Age 50-59 |
Age 60-69 |
Age 70-79 |
| < 160 |
0 |
0 |
0 |
0 |
0 |
| 160-199 |
4 |
3 |
2 |
1 |
0 |
| 200-239 |
7 |
5 |
3 |
1 |
0 |
| 240-279 |
9 |
6 |
4 |
2 |
1 |
| > or = 280 |
11 |
8 |
5 |
3 |
1 |
4. Do you smoke?
| |
Points |
| |
Age 20-39 |
Age 40-49 |
Age 50-59 |
Age 60-69 |
Age 70-79 |
| Nonsmoker |
0 |
0 |
0 |
0 |
0 |
| Smoker |
8 |
5 |
3 |
1 |
1 |
5. What is your blood pressure (mm Hg)?
| |
Points |
| Systolic (top number) BP: |
Untreated |
Treated with medication |
| < 120 |
0 |
0 |
| 120-129 |
0 |
1 |
| 130-139 |
1 |
2 |
| 140-159 |
1 |
2 |
| > or = 160 |
2 |
3 |
6. What is your 10-year risk?
| Points total: |
<0-4 |
5-6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
14 |
15 |
16 |
> or =17 |
| Ten-year risk percentage |
< or =1 |
2 |
3 |
4 |
5 |
6 |
8 |
10 |
12 |
16 |
20 |
25 |
> or =30 |
| |
My 10-year risk is ------------------------% |
|
|
|
|
|
|
10-Year Risk Calculator for Women
1. What is your age?
| Age |
Points |
| 20-34 |
-7 |
| 35-39 |
-3 |
| 40-44 |
0 |
| 45-49 |
3 |
| 50-54 |
6 |
| 55-59 |
8 |
| 60-64 |
10 |
| 65-69 |
12 |
| 70-74 |
14 |
| 75-79 |
16 |
2. What is your HDL cholesterol (mg/dL)?
| HDL |
Points |
| > or = 60 |
-1 |
| 50-59 |
0 |
| 40-49 |
1 |
| < 40 |
2 |
3. What is your total cholesterol (mg/dL)?
| |
Points |
| Total Cholesterol |
Age 20-39 |
Age 40-49 |
Age 50-59 |
Age 60-69 |
Age 70-79 |
| < 160 |
0 |
0 |
0 |
0 |
0 |
| 160-199 |
4 |
3 |
2 |
1 |
1 |
| 200-239 |
8 |
6 |
4 |
2 |
1 |
| 240-279 |
11 |
8 |
5 |
3 |
2 |
| > or = 280 |
13 |
10 |
7 |
4 |
2 |
4. Do you smoke?
| |
Points |
| |
Age 20-39 |
Age 40-49 |
Age 50-59 |
Age 60-69 |
Age 70-79 |
| Nonsmoker |
0 |
0 |
0 |
0 |
0 |
| Smoker |
9 |
7 |
4 |
2 |
1 |
5. What is your blood pressure (mm Hg)?
| |
Points |
| Systolic (top number) BP: |
Untreated |
Treated with medication |
| < 120 |
0 |
0 |
| 120-129 |
1 |
3 |
| 130-139 |
2 |
4 |
| 140-159 |
3 |
5 |
| > or = 160 |
4 |
6 |
6. what is your 10-year risk?
| Points total: |
< or = 9-12 |
13-14 |
15 |
16 |
17 |
18 |
19 |
20 |
21 |
22 |
23 |
24 |
> or = 25 |
| Ten-year risk percentage |
< or = 1 |
2 |
3 |
4 |
5 |
6 |
8 |
11 |
14 |
17 |
22 |
27 |
> or = 30 |
| |
My 10-year risk is ------------------------% |
|
|
|
|
|
Source: Adapted from NCEP publication "High Blood
Cholesterol, What You Need to Know," available at http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm. The 10-Year Heart Attack Risk Calculator can also be accessed on the NHLBI Website: http://www.nhlbi.nih.gov/health/index.htm.
Determine your risk category
When you visit your physician, he or she will complete a more complicated assessment of your risk and look beyond simply your LDL cholesterol value, as high LDL cholesterol is only one major risk factor. Your doctor will likely determine your chances of developing heart disease using the NCEP protocol, a multi-step calculation based on a point system that incorporates LDL in combination with several other risk factors, such as a strong family history of cardiovascular disease and your Framingham ten-year risk score.
Your final score enables your doctor to categorize you into a five-tier risk stratum: Category I, very high risk; Category II, high risk; Category III, moderately high risk; Category IV, moderate risk and Category V, lower risk. These categories direct and facilitate treatment protocols for physicians to treat patients depending on their level of risk. (Each category has a different LDL goal, with the highest risk, Category I, having the lowest LDL goal number.)
What is my treatment category?
Utilizing your medical
history, number of major risk factors, and 10-year risk score enables your physician to categorize you into a treatment category and give you an LDL goal. Your physician may use this method to determine treatment options for you - and whether you are a potential candidate for statin drug therapy.
Medical History and
10-year Risk Score |
|
Treatment
Category |
|
LDL
Goal |
|
Possible
Treatment Options |
Previously diagnosed
cardiovascular disease
together with any of the
following: multiple risk
factors (especially
diabetes), continued
smoking, metabolic
syndrome, or a recent
heart attack |
|
Very high risk |
|
Below 70 mg/dL |
|
Diet and exercise, plus
your MD will consider
drug treatmen |
Previously diagnosed
cardiovascular disease
or diabetes or 2 or more
risk factors that give you
a 10-year risk of
> 20 percent |
|
High risk |
|
Below 100 mg/dL |
|
Diet and exercise, plus
your MD will consider
drug treatment |
2 or more risk factors
and a 10-year risk of
10-20 percent |
|
Moderately
high risk |
|
Below 130 mg/dL |
|
Diet and exercise, plus
your MD may consider
drug treatment to get
LDL to < 100 mg/dL |
2 or more risk factors
and a 10-year risk of
< 10 percent |
|
Moderate risk |
|
Below 130 mg/dL |
|
Diet and exercise, plus
your MD may consider
drug treatment if LDL
> or = 160 mg/dL |
| 0-1 risk factors |
|
Lower risk |
|
Below 160 mg/dL |
|
Diet and exercise, plus
your MD may consider
drug treatment if LDL
> or = 190 mg/dL or LDL
is 160-189 mg/dL
and 1 severe risk factor |
Source: Adapted from Scott M. Grundy et al., for the Coordinating Committee of the National Cholesterol Education Program, "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines," Circulation 110 (2004): 227-239.
Source: Cholesterol Down, Foreword by Jennifer H. Mieres, M.D. |
