Rating Your Risk of Heart Disease and Stroke.

You know your blood pressure, your total cholesterol, maybe even your HDL and LDL. But what do those numbers tell you about your chances of getting heart disease or stroke?

Get out your pencils. You're about to find out.

Between 1971 and 1974, researchers took the blood pressure and measured the cholesterol of more than 5,000 residents of Framingham, Massachusetts, who were between the ages of 30 and 74 and were free of heart disease. Over the next 12 years, 993 of them were diagnosed with--or died of--heart disease.

The researchers then went back and compared the medical records of the people who got heart disease with the records of those who didn't.(1) They used that information to create the questionnaire on pages 10 and 11, which estimates a person's chances of getting heart disease during the next ten years.

"It's like a report card, and your overall grade point average is your risk," says Peter Wilson, who spearheaded the questionnaire's development as director of laboratories at the i Framingham Heart Study. "You may get a few As and think that's great, but it's the Cs that are going to drag your average down and give you heart disease."

Calculating your score alerts you to what you should be trying to improve, and by how much, says Wilson.

But, like most rating systems, this one still has some wrinkles. For example:

* Whites only? The scores calculate your risk of heart disease and stroke based on information gathered from the residents of a predominantly white, middle-class community about 30 miles west of Boston. If you aren't white and aren't middle class, your risks may be smaller or larger. Researchers just don't have good numbers.

* How old? All of the Framingham residents who participated in the heart disease study were under age 75. The stroke risk questionnaire (see page 12) is based on older data from more than 40 years of studying Framingham residents, so it includes people up to age 86. If you're older than 75 or 86, you can still use both questionnaires. You won't get an exact read on your risk, but you can assume that it's at least as great as if you were in the oldest age group listed.

* Women over 55? If that's you, the score for heart attack may underestimate your true risk ... probably because there weren't enough women over 55 in Framingham to get good statistics. Heart disease is galloping among women past the age of menopause, yet the "Compare Your Risk" chart on page 11 shows little or no increase for women after age 55. That suggests that there's a problem with the Framingham data.

* Other risk factors? The questionnaires don't ask about family history of heart disease, how active you are, or whether you're overweight. Why? To begin with, it's hard to put a number on how much they contribute to heart disease. What's more, they probably show up in the questionnaire in other ways. If you weigh too much or don't exercise, for example, you're likely to have high blood pressure or diabetes.

If you have questions about whether a risk factor applies to you, of if you want to discuss the results, talk to your doctor.

(1) Circulation 97: 1837, 1998.

GLOSSARY

Heart Disease

HDL--Your "good" cholesterol, measured after an overnight fast.

LDL--Your "bad" cholesterol, measured after an overnight fast.

Diastolic Blood Pressure--The lower of your two blood pressure numbers.

Systolic Blood Pressure--The higher of your two blood pressure numbers.

EXAMPLE FOR HEART DISEASE RISK

A 50-year-old woman (6 points) with total cholesterol of 223 (1 point), HDL ("good") cholesterol of 45 (1 point), and blood pressure of 142 over 89 (2 points) who doesn't smoke (0 points) but who has diabetes (4 points) ends up with a score of 14 points. According to the "What's Your Risk?" chart, she has an 18 percent chance of developing heart disease over the next ten years (we calculated her risk using the "If You Used Total Cholesterol" column). That's far greater than the five-percent risk of a "low-risk" person her age or the eight-percent risk of an "average-risk" person.

Stroke

AF--Has a doctor ever told you that you have atrial fibrillation (irregular heart beats in the upper chambers of your heart)?

CVD--Have you ever had any of these five conditions:

1. Heart attack.

2. Angina (chest pain during physical activity).

3. Unstable angina or coronary insufficiency (the symptoms of a heart attack, but with no increase in the enzymes that signal heart muscle damage).

4. Intermittent claudication (severe leg pain, usually upon exertion, that results from an inadequate blood supply).

5. Congestive heart failure (symptoms like breathlessness and severely swollen ankles caused by the heart's failure to pump enough blood and oxygen).

HYP RX--Do you take medication to tower your blood pressure?

LVH--Has an electrocardiogram ever shown that you have left ventricular hypertrophy (an enlarged heart muscle)?

SBP--Your systolic blood pressure (the higher of your two blood pressure numbers).

HEART DISEASE

Step 1. Find the point for your age

Age     Men    Age    Women

30-34   -1    30-34    -9
35-39    0    35-39    -4
40-44    1    40-44     0
45-49    2    45-49     3
50-54    3    50-54     6
55-59    4    55-59     7
60-64    5    60-64     8
65-69    6    65-69     8
70-74    7    70-74     8

Step 2.

Find the points for your LDL. If you don't know your LDL, find the points for your Total Cholesterol (don't use both).

LDL           Men   Women

below 100     -3     -2
100-159        0      0
160-189        1      2
190 or more    2      2

                 OR
Total
Cholesterol   Men   Women

below 160     -3     -2
160-199        0      0
200-239        1      1
240-279        2      1
280 or more    3      3

Step 3.

Find the points for your HDL

HDL           Men   Women

below 35       2      5
35-44          1      2
45-49          0      1
50-59          0      0
60 or more    (*)    (*)

(*) Women with HDL of 60 or more: Your score is -2 if you used your LDL for Step 2 and -3 if you used your Total Cholesterol for Step 2.

(*) Men with HDL of 60 or more: Your score is -1 if you used your LDL for Step 2 and -2 if you used your Total Cholesterol for Step 2.

Step 4. Find the points for your blood pressure. Locate your systolic pressure (the higher number) down the left column. The move to the right along that row until you reach the column with your diastolic pressure (the lower number). For example, a woman with blood pressure of 120/90 would score 2 points.

[ILLUSTRATION OMITTED]

Step 5.

Find the points if you have diabetes or smoke.

Other          Men   Women
Risk
Factors

if you have
diabetes        2      4
if you smoke    2      2

Step 6. Add up the points for all of your risk factors

Age              +

LDL or Total
Cholesterol      +

HDL

Blood Pressure   +

Other
Risk Factors     +

Total Points

Note: Subtract minus points.

What's Your Risk

Here's your risk of getting heart disease within the next ten years.

   Total            If You            If You Used Total
   Points      Used LDL in Step 2   Cholesterol in Step 2

                  Men    Women           Men        Women

less than -2       1%      1%        less than 2%     1%
     -2            2%      1%        less than 2%     1%
     -1            2%      2%             2%          2%
      0            3%      2%             3%          2%
      1            4%      2%             3%          2%
      2            4%      3%             4%          3%
      3            6%      3%             5%          3%
      4            7%      4%             7%          4%
      5            9%      5%             8%          4%
      6           11%      6%            10%          5%
      7           14%      7%            13%          6%
      8           18%      8%            16%          7%
      9           22%      9%            20%          8%
     10           27%     11%            25%         10%
     11           33%     13%            31%         11%
     12           40%     15%            37%         13%
     13           47%     17%            45%         15%
 14 or more       56%      --            53%          --
     14            --     20%             --         18%
     15            --     24%             --         20%
     16            --     27%             --         24%
 17 or more        --     32%             --         27%

Compare Your Risk

Once you've calculated your risk of getting heart disease within the next ten years (see "What's Your Risk?"), you can compare it to the heart disease of an "average" or a "low-risk" person your age.

Age            Average Risk           Low Risk

            Men      Women       Men      Women

30-34        3%   less than 1%    2%   less than 1%
35-39        5%   less than 1%    3%   less than 1%
40-44        7%        2%         4%       2%
45-49       11%        5%         4%       3%
50-54       14%        8%         6%       5%
55-59       16%       12%         7%       7%
60-64       21%       12%         9%       8%
65-69       25%       13%        11%       8%
70-74       30%       14%        14%       8%

A low-risk person doesn't smoke or have diabetes and has blood pressure of below 130/below 85, LDL of 100 to 129 or total cholesterol of 160 to 199, and HDL of 45 or more (men) or 55 or more (women).

Step 1.

Find the points for your age.

Age     Women

54-56     0
57-59     1
60-62     2
63-65     3
66-68     4
69-71     5
72-74     6
75-77     7
78-80     8
81-83     9
84-86    10

Step 1.

Find the points for your age.

Age      Men

54-56     0
57-59     1
60-62     2
63-65     3
66-68     4
69-71     5
72-74     6
75-77     7
78-80     8
81-83     9
84-86    10

Step 3. Total the points for all your risk factors

Age            +
SBP            +
HYP            +
Diabetes       +
Cigarette      +
Smoker
AF             +
LVH            +
Total Points

Step 2.

Find the points for your other risk factors.

   SBP    Points          HYP RX              Diabetes
                          No = 0          No = 0    Yes = 3
 95-104      0       If Yes, add these
105-114      1     points, depending on      Cigarette
115-124      2        your SBP level:          Smoker
125-134      3                            No = 0    Yes = 3
135-144      4        SBP     Points
145-154      5       95-104     6                CVD
155-164      6      105-124     5         No = 0    Yes = 2
165-174      7      125-134     4
175-184      8      135-154     3                AF
185-194      9      155-164     2         No = 0    Yes = 6
195-204     10      165-184     1
                    185-204     0                LVH
                                          No = 0    Yes = 4

Step 2. Find the points for your other risk factors.

  SBP     Points

 95-105      0          HYP RX          CVD
106-116      1          No = 0         No = 0
117-126      2         Yes = 2        Yes = 3
127-137      3
138-148      4         Diabetes          AF
149-159      5          No = 0         No = 0
160-170      6         Yes = 2        Yes = 4
171-181      7
182-191      8     Cigarette Smoker     LVH
192-202      9          No = 0         No = 0
203-213     10         Yes = 3        Yes = 6

Compare Your Risk

Compare your stroke risk to that of an average person your age.

 Age    Men    Women

55-59    3%      6%
60-64    5%      8%
65-69    7%     11%
70-74   11%     14%
75-79   16%     18%
80-84   24%     22%

What's Your Risk

Here's your risk of having a stroke within the next ten years.

Points   Men   Women

  1      3%     1%
  2      3%     1%
  3      4%     2%
  4      4%     2%
  5      5%     2%
  6      5%     3%
  7      6%     4%
  8      7%     4%
  9      8%     5%
  10     10%    6%
  11     11%    8%
  12     13%    9%
  13     15%    11%
  14     17%    13%
  15     20%    16%
  16     22%    19%
  17     26%    23%
  18     29%    27%
  19     33%    32%
  20     37%    37%
  21     42%    43%
  22     47%    50%
  23     52%    57%
  24     57%    64%
  25     63%    71%
  26     68%    78%
  27     74%    84%
  28     79%     -
  29     84%     -
  30     88%     -