OK, so you know the major risk factors for heart attack in the population at large. Perhaps now you'd like to be able to estimate your own specific risk.
The Framingham Heart Study has been looking at risk factors for heart disease among residents of Framingham, Mass., since 1948. In 1998, the study's researchers produced a scoring system to estimate your risk of heart disease (heart attack or angina) over the next 10 years - you can calculate your own score.
This worksheet gives the 10-year risk for any type of heart disease, heart attack, or angina. It applies only to men and women between the ages of 30 and 74 who have no previously known heart disease.
Noteworthy, too, is the fact that the calculations are based on one population of mostly Caucasian people in one suburb of Boston. Their data, therefore, may not be applicable to people of different ancestries or cultures or who have other major lifestyle differences. In fact, many studies have shown that this risk score is too high in some groups and too low in others.
This risk estimate incorporates your age, gender, blood pressure, HDL cholesterol, smoking status, and the presence or absence of diabetes. It also includes either your total cholesterol or LDL cholesterol (LDL is preferred, if you know it). However, there are several factors that can make this estimate less accurate:
- Blood pressure varies a lot during the day, so an unusually high or low reading can change the result.
- This estimate doesn't consider how well controlled your diabetes is or how long ago you may have quit smoking.
- It doesn't include family history of heart disease, which is one of the major risk factors.
Another risk calculator, also based on the Framingham data, is available from the National Heart, Lung and Blood Institute. This one gives the 10-year risk only for heart attack (not angina) for people ages 30-79 who have no prior history of heart disease.
It is based on the same population and so has many of the same limitations as the other calculator. In addition, this one does not consider LDL cholesterol or diastolic blood pressure measurements.
In my practice, I try to avoid these and similar calculators. One of my biggest concerns is that they only estimate your risk for the next 10 years. What about for the rest of your life? My goal is to prevent you from ever having a heart attack, or at least delay it as long as possible.
I prefer instead to identify all of a patient's individual risk factors and encourage him or her to modify anything that can be changed. Every risk factor should be reduced as much as possible by making positive changes in one's lifestyle, with medications being added when necessary to control diabetes, hypertension, and high cholesterol.
The known or estimated odds of a heart attack in the near future might help people make some decisions. But even with a low risk estimate, there is still some chance of being that unlucky one who develops the disease.
Regardless of your Framingham risk score, your odds of delaying or avoiding that first heart attack - and your overall health - improve with every healthy choice you make.