It is important for you to know how to assess your own risk for heart disease.
The bad news about heart disease is that it remains extremely prevalent in our society. The good news is that the factors that determine our risk of developing heart disease are, to a large extent, under our control. We ourselves have a lot to say about whether we will develop early cardiac disease.
Your doctor is supposed to assess your risk for you, and coach you on what you should be doing to reduce that risk. But, despite pleas from medical experts and professional societies to do so, many doctors are still bad at performing risk assessments, and are particularly terrible about spending the necessary time to instruct their patients on appropriate steps to reduce that risk.
(Note well: Doing a simple risk assessment is one of the most important jobs the primary care physician does. The failure to do such a risk assessment probably ought to be considered evidence that your doctor may be doing sub-standard work. Many of the things doctors need to think about are complicated - this one isn't.)
Fortunately, the tools exist today for you to accurately estimate your own risk of getting heart disease, without waiting for your doctor to initiate the action. And lots of information is available as to what to do about it if your risk is elevated.
To assess your own risk, here's what you need to know
You need to gather the following information:
- whether you smoke or not
- your total and HDL cholesterol levels
- your blood pressure
- whether you have evidence of diabetes or metabolic syndrome
- whether you are overweight for your age and height
- whether close relatives have had premature heart disease
With this information, you can place yourself into one of three categories: low, intermediate, or high.
To be in the low risk category, all of the following must be present:
- total cholesterol less than 200 mg/dL, HDL cholesterol greater than 40 mg/dL
- systolic BP less than 120, diastolic BP less than 80
- no evidence of diabetes
- not overweight
- no family history of premature cardiovascular disease
You are in the high risk category if you have any of the following:
- known coronary artery disease or other vascular disease
- type 2 diabetes
- over age 65 with multiple (more than one) risk factors
And you are in the intermediate risk group if you don't fit into either the low or high risk groups.
If you are at low risk, you do not need any special medical interventions to reduce your risk, except perhaps for routine coaching on maintaining a healthy lifestyle. About 35% of U.S. adults fall into this category.
If you are in the high risk group, your doctor should strongly consider placing you on appropriate treatments that have been proven to reduce the risk of heart attack and death, such as statin drugs, beta blockers, and/or aspirin. In addition, your doctor may want to do a stress/thallium study to assess whether you may have significant coronary artery disease already. About 25% of U.S. adults are in the high-risk category. Here is more on what to do if you are in the high risk category.
If you are in the intermediate risk group, you should should take aggressive steps to modify the risk factors keeping you out of the low risk category. Also, you should discuss with your doctor whether further testing should be done to characterize your risk more accurately. Such testing might include having your C-reactive protein (CRP) level measured, and perhaps getting a calcium scan. Roughly 40% of U.S. adults are in the intermediate risk category.
Again, if your doctor has not performed a formal cardiac risk assessment, you should estimate your risk yourself. And, if your risk appears to be intermediate or high, you need to talk to your doctor about taking aggressive measures to prevent heart disease.
Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease. Lancet 1999 Jan 9;353(9147):89-92.