Practice of the Month: Review Checklist to Assess Your Heart Attack Risk
There are many factors that determine if one is at risk of having a heart attack. There are a few factors we cannot control, such as age, sex, and family history, however, most risk factors can be managed with lifestyle changes and, if necessary, medication, making heart disease a preventable condition.
About one-quarter to one-third of U.S. adults have high LDL (low-density lipoprotein) cholesterol. Nearly half have hypertension, defined as blood pressure 130/80 mm Hg or higher. Nearly 40 percent of Americans have prediabetes and 15 percent have diabetes. One-third of Americans are overweight and 40 percent are obese. These risk factors for heart disease are mostly preventable with a healthy lifestyle.
“Daily exercise is the best medicine to prevent heart attack. When risk factors persist despite a healthy lifestyle, people should work with their doctor to find medication that they tolerate to control the risk factor,” says Dr. David Maron, Stanford Cardiologist and Chief of the Stanford Prevention Research Center.
To assess your risk, put a check mark next to the factors that apply to you:
Lifestyle Factors:
- Smoking or vaping nicotine; exposure to secondhand smoke
- Lack of physical activity (less than 150 per week of moderate activity)
- Poor diet (high in red meat, trans fats, refined carbs, sugary drinks; low in fruits, vegetables, whole grains, legumes, nuts, fish)
- Excessive alcohol use (more than 2 drinks per day for men, 1 for women; or binge drinking)
- Poor sleep (less than 7 hours per night or poor quality due to sleep apnea or insomnia)
- Social isolation, high chronic stress, and/or depression
Medical Conditions:
- Coronary artery calcium (CAC) score > 100 via CT scan
- High blood pressure (≥130/80 mmHg)
- High LDL cholesterol
- High hemoglobin A1c or high blood sugar: diabetes (A1c ≥5% or fasting glucose >126 mg/dL) or prediabetes (A1c 5.7 – 6.4% or fasting glucose 100-125 mg/dL)
- Weight: obesity (BMI ≥30) or central obesity (waist > 40 inches for men, > 35 inches for women)
- Chronic kidney disease or reduced eGFR
- High triglycerides (≥150 mg/dL or 1.7 mmol/L)
- Sleep apnea or insomnia
- Inflammatory/autoimmune disease (e.g., rheumatoid arthritis, lupus, psoriasis)
- Adverse pregnancy outcomes (e.g., preeclampsia, eclampsia, gestational diabetes, preterm birth)
- Erectile dysfunction (can be an early marker of vascular disease)
- Elevated high-sensitivity CRP (hs-CRP ≥2mg/L)
- Elevated Lp(a) (≥ 50 mg/dL or ≥125 nmol/L)
“The more points you check—especially blood pressure, LDL cholesterol, diabetes, smoking, kidney disease—the higher your risk,” says Dr. Maron. “I recommend adults aged 40 to 75 with at least one of these risk factors or conditions get a coronary artery CT scan to determine if they have calcified plaque buildup in the coronary arteries to more accurately assess risk of heart attack.”
