Heart Disease Risk Assessment

FACTORS YOU CANNOT CHANGE

1. Family History
Do you have a close relative (grandparent, parent, brother or sister) who developed heart disease?
Yes/No

2. Personal Medical History
Have you been diagnosed with heart disease?
Yes/No

3. Age & Sex
Are you male over 40 years old or female over 50 years old?
Yes/No

4. Diabetes
Have you been diagnosed with diabetes?
Yes/No

FACTORS YOU CAN CHANGE

5. Cholesterol
Is your cholesterol level in the unhealthy range? (TC over 200 and/or TC/HDL ratio higher than 5.0?)
Yes/No

6. Blood Pressure
Is your blood pressure higher than 140/90 mm Hg?
Yes/No

7. Arterial Elasticity Test
Do you have a Pattern other than Pattern A or B?
Yes/No

8. Smoking
Do you smoke or have you smoked in the past?
Yes/No

9. Body fat
Are you overweight and/or have a high body fat percentage?
(BMI of more than 25 or more indicates overweight & body fat percentage of 25% or higher for men and 30% or higher for women indicates high body fat percentage.)
Yes/No

10. Exercise
Do you maintain at least 30-45 minutes of aerobic activity 3 days per week?
Yes/No

11. Stress
Are you frequently tense, angry, irritable, or in a hurry?
Yes/No

12. Alcohol Intake
Do you drink more than two alcoholic beverages per day?
Yes/No

TOTAL SCORE _______________

If you answered YES to 0-3 question(s) … Low Risk for Coronary Heart Disease
If you answered YES to 4-6 questions … Moderate Risk for Coronary Heart Disease
If you answered YES to 7 questions or more … High Risk for Coronary Heart Disease