Rating Your Cholesterol-Related Risk
In This Chapter
� Running through the tests to count your cholesterol and check your arteries
� Explaining why your cholesterol level is where it is
� Adapting adult cholesterol goals for kids
� Explaining how cholesterol’s effects change with age
� Figuring your own personal chance for heart attack
This chapter is totally straightforward. The information here has just one purpose: to provide answers to three basic questions and make it possible for you to evaluate your own cholesterol-related risk of heart disease (the whole range of heart problems) and heart attack (the 800-pound gorilla). As for those three basic questions, here they are:
- Question #1: What’s the real definition of high cholesterol?
- Question #2: Who’s likely to have high cholesterol?
- Question #3: Are you at risk for high cholesterol?
My editors remind me that I should tell you to grab a pencil before you start reading this chapter because I include several tests for you to fill out at the end. Meanwhile, avanti! (That’s Italian for, “Let’s get to it!”)
Categorizing Cholesterol as a Risk Factor
Generally, medical risk factors fit into one of three basic categories:
� Risk factors you can’t control
� Risk factors you can control
� Risk factors whose effects you can lessen but not entirely eliminate
High cholesterol is an interesting risk factor because it fits into all three of these categories. Take a look at the evidence:
� Your genes determine how much cholesterol your body produces naturally, so high cholesterol may be a risk factor you can’t control.
� You can take one of several different cholesterol-lowering drugs designed to pull your cholesterol down to safe levels, so high cholesterol may be a risk factor you can control. (For more about cholesterol-lowering drugs, check out Chapter 12.)
� You can change your diet, lose weight, and exercise to increase your “good” cholesterol, high-density lipoproteins (HDLs), while lowering your “bad” cholesterol, low-density lipoproteins (LDLs), so high cholesterol (or at least high “bad” cholesterol) may be a risk factor whose effects you can soften.
My point? Although high cholesterol is an important risk factor for heart disease — and decreasing your longevity — you have a leading role to play in controlling the risk. What you eat, how you spend your leisure time, and how you work with your doctor have much to do with determining where your rank is on the cholesterol scale. Interesting proposition, eh?
Adding Up Your Basic Cholesterol Numbers
Before you decide what to do about your cholesterol, you need to know how much cholesterol you actually have. So get up, march over to your doctor’s office, and hold out your arm so your doctor can stick a hollow needle into the vein in the crook of your elbow and draw about 20 milliliters (ml) of bright, red blood. Then when you go home, the little glass tube holding your blood goes off to a medical laboratory where a technician counts the cholesterol particles. The results you get back look like this: 225 mg/dL. Translation: You have 225 milligrams of total cholesterol in every deciliter (1⁄10 liter) of blood.
But these numbers don’t paint the whole picture. The figures for your low- density lipoproteins (VLDLs, IDLs, LDLs) and high-density lipoproteins (HDLs) are still missing. Shaky on the details? You can read all about these little fellas in Chapter 2, which explains that lipoproteins are fat-and-protein particles that carry cholesterol into your arteries (LDLs) or out of your body (HDLs), which is why HDLs are “good” and some of the LDLs are “bad.”
The problem with simple finger-stick tests such as those found in cholesterol home-testing kits is that they only measure total cholesterol levels — no HDLs and no LDLs. An incomplete result (total cholesterol alone) can scare you to death if it shows you have high total cholesterol without letting you know that you — lucky girl! lucky boy! — also have high HDLs. The finger- stick test can also provide false reassurance if it shows a low total cholesterol level without letting you know that your LDLs are also very low.
Now that you know all this and have an accurate, complete doctor’s report in hand, what do the results say about you? How can you tell if the numbers are high, low, or in-between?
Defining Higher, Lower, Medium — and Just Right
The information you need to grade your cholesterol levels comes from the usual suspects — I mean the usual experts: the National Cholesterol Education Program (NCEP) at the National Heart, Lung, and Blood Institute (NHLBI), an arm of the National Institutes of Health (NIH).
In 2001, the NCEP issued a report called ATP III, short for The Third Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. In this report, the NCEP said:
� A total cholesterol level higher than 240 mg/dL translates into a “high risk” for heart disease.
� A total cholesterol level between 200 and 239 mg/dL means there’s a “moderate risk” for heart disease.
� A total cholesterol level below 200 mg/dL is “desirable.”
Regardless of total cholesterol levels, the risk of heart attack is highest among men whose HDLs are lower than 37 mg/dL and women whose HDLs are lower than 47 mg/dL. Conversely, the risk of heart attack is lowest among men whose HDLs are higher than 53 mg/dL and women whose HDLs are higher than 60 mg/dL.
Table 3-1 shows the current descriptions of various levels of total cholesterol, LDL cholesterol, and HDL cholesterol.
But in July 2004, just when everyone thought they had the numbers down pat, the experts at the NCEP added a footnote: People at high risk should push their LDLs down below 100 mg/dL, a task that requires taking one or more of the cholesterol-busting drugs described in Chapter 12.
Are these recommendations final? Probably not. Experience shows that precise numbers for healthful cholesterol levels can change at any moment. What doesn’t change are the basics: Higher HDLs are good. Lower LDLs are good. Sooner or later, like Goldilocks and the Three Bears, someone will figure out exactly how low and how high is just right.
Blood circulates through a system of vessels called arteries and veins. Arteries carry blood away from the heart; veins carry blood back to the heart. The average human body has about 5 quarts of blood. Large people may have slightly more; small people may have slightly less. Every 60 seconds, about 1⁄5 quart of blood flows out of your heart through your coronary arteries. Sixty seconds after that, the blood zips through your entire circulatory system and heads back to your heart.
The life span of one red blood cell is about 120 days for a man and about 14 days less for a woman. Men have more red blood cells — about 4.5 to 6.2 million per cubic microliter of blood compared to 4 to 5.5 million for women. Because males have more red blood cells, they also have higher values of hemoglobin, the pigment in red blood cells that carries oxygen throughout the body. They also have higher levels of iron, an important element in hemoglobin.
White blood cells play a primary role in your immune system as avengers that zero in on invaders, such as bacteria, to chew them up and spit them out. The normal number of white blood cells is exactly the same for men and women — 4,100 to 10,900 per microliter of blood.
Blood is a vehicle for nutrients, medications, and other circulating particles such as — what a surprise — the lipoproteins that carry cholesterol. By the way, the blood for a cholesterol test always comes from a vein, not an artery. Blood from a vein is easier and safer to obtain, and it’s a representative sample of what’s in your body. And yes, clenching your fist does make your vein pop up so it’s easier to puncture.
Listing Other Risk Factors
According to the American Heart Association, as you read this chapter an estimated 105,200,000 Americans have total cholesterol levels higher than 200 mg/dL, putting them all into the borderline high category; 36.6 million of those have high total cholesterol levels above 240 mg/dL. Who are all these people? What puts them into these special high-risk categories?
Age and gender
Among people younger than 50, men are more likely to have high cholesterol. After age 50, women edge into the lead. Either way, a woman’s blood vessels are more elastic than a man’s blood vessels. As a result, women have a little more protection than men throughout their lives against a blood clot that may block their blood vessels and trigger a heart attack.
Pregnancy — strictly a female activity — lowers a woman’s levels of good HDLs, but a study of 1,051 women conducted by researchers at Kaiser Permanente in Oakland, California, showed that nursing the newborn for longer than three months is protective and reduces the decline of HDLs.
Counting kids’ cholesterol
The cholesterol levels shown in Table 3-1 earlier in this chapter are for grown-ups. (Translation: Adults are people between the ages of 20 and 74.) The recommendations for children are a different story. A child’s total cholesterol level rises slowly from age 2 to age 10 and then begins to rise and fall in a gender-related pattern. According to University of Texas (Houston) researcher Darwin R. Labarthe, a girl’s cholesterol level is likely to peak around age 9, a boy’s around age 16. Conversely, a girl’s cholesterol level goes down for a while around age 16; a boy’s cholesterol goes down for a while around age 17.
All adults should be tested at least once to establish a baseline cholesterol reading; if the level is higher than it should be, more frequent testing may be required. But as of this writing, the American Academy of Pediatrics (AAP) only recommends cholesterol testing for a relatively small number of children:
� Kids with a parent or grandparent who had a heart attack, suffered a stroke, or received a diagnosis of coronary artery disease before age 55
� Children whose parents have high cholesterol (above 240 mg/dL)
The recommendations of the American Heart Association (AHA) are similar to those of the AAP. The AHA suggests only testing children older than the age of 2 who have a family history of coronary artery disease — a parent or a grandparent with high cholesterol or a history of heart disease.
Table 3-2 shows the AHA-recommended cholesterol levels for children and adolescents between the ages of 2 and 19.
Lower isn’t always safer
You get your blood test back from your doctor and — wonder of wonders — your cholesterol has dropped! Time to celebrate? Not necessarily.
A steady, gradual decrease in cholesterol due to a cholesterol-control diet (see Chapter 4) or one of the new cholesterol-lowering medications (see Chapter 12) is great. But a sudden, unexplained decline in total cholesterol — hypocholesterolemia in doctor-speak — may be a pre-clinical sign (something that shows up before disease is evident) of malnutrition, an overactive thyroid, cirrhosis of the liver, certain forms of cancer, or genetic mutations. All of these factors can drop total cholesterol levels to the basement (<100 mg/dL).
And get this: According to a 2007 report on a 2,000-person study at the Aging Research Center at the Karolinska Institute in Stockholm, Sweden, a sudden unexplained drop in cholesterol levels at mid-life, around age 50, may be a risk factor for cognitive problems (translation: dementia) later on. Sometimes it seems you can’t win for losing!
Gilding the golden years
Pssst! Come over here. I have a secret to share with you. As people turn 70 and sail into their eighth decade, their cholesterol level becomes a less important predictor of death by heart disease.
What should you make of this?
� Perhaps people who die of cholesterol-induced coronary artery disease simply check out earlier in life. After all, cholesterol is often described as a risk factor for an early heart attack.
� Perhaps, as you age, your cholesterol level becomes less important than your overall health.
� Perhaps total cholesterol levels aren’t as important as LDL and HDL levels, which aren’t reflected in studies that show the decreasing importance of cholesterol levels as a predictor of death by heart disease as people age.
Should you rush out to tell grandma and grandpa to toss out that salad and start gorging on high-fat, high-cholesterol foods? Not yet. But you can send them a postcard with this comment from the American Heart Association: “The issue of cholesterol levels in the elderly is still unclear.”
Ethnicity
The cholesterol stats on ethnic groups in the United States are, to put it mildly, incomplete. Many stats exist for non-Hispanic Blacks, non-Hispanic Whites, and Mexican Americans. Scattered statistics exist for Native Americans, but there are no numbers for other ethnic groupings. As a result, given the variety of human beings in the U.S., it’s hard to figure out exactly which ethnic groups are most at risk of high cholesterol.
Nonetheless, Table 3-3, Table 3-4, and Table 3-5 provide useful — though, repeat, incomplete — guides. The tables show the percentage of 99,900,000 Americans (48,400,000 men and 51,500,000 women) age 20 and older whose cholesterol, LDL, or HDL levels put them at increased risk of heart disease in 2003.
Yes, this study predates the American Heart Association estimate of 105,200,000 adults with cholesterol levels above 200 mg/dL cited above (see “Listing Other Risk Factors” earlier in this chapter). That’s life in statistics-land.
Evaluating Your Own Risk Factors File
Now that you know what’s high and what’s low in the wide world of choles- terol and who’s likely to have high cholesterol and who isn’t, you can turn your attention to the specifics for one person: you. This section helps you figure out your very own personal risk of having high cholesterol. Begin at the beginning: your family.
When the “A” list rates a “B”
According to Ronald M. Krauss of the University of California (Berkeley), not everyone is created equal when it comes to LDL (the “bad” cholesterol) production. First in 2001 and then in follow- up studies in 2004 and 2005, Krauss proposed that genes tend to divide people into two groups of LDL-makers.
Some people — the A list — make big, bouncy LDLs. Others — the B list — make smaller, denser LDLs. (Need to know more about density — as in low-density lipoproteins? See Chapter 2.)
The B people tend to get better results when they go on low-fat, carb-based diets to reduce over- all cholesterol levels, dropping levels of both the big LDLs and the little LDLs, which results in an overall reduction in LDL cholesterol. The A people lose a lot of big, non-threatening LDLs, but their overall level of small, dense LDLs (the bad guys) rises. The catch is that nobody has yet identified the gene that determines whether you are an A or a B. Stay tuned.
The family
Your family history says a lot about your future. Your genes are a family trait, so if your first-degree relatives — father, mother, brothers, and sisters — have high cholesterol, you may too. If your father or brother had a heart attack when he was younger than 55 or your mother or sister had a heart attack before she turned 65, you need to watch your other risk factors.
But, all things being relative, your relatives’ cholesterol levels may not mirror yours. In my family, my mother has high cholesterol, and so do I. My father had low cholesterol, and so does my sister who, I might point out, also got the good nails and curly hair. Life can be sooooooo unfair!
You, yourself, and you
Some medical conditions either affect your risk of having high cholesterol or intensify cholesterol’s bad effects. If you have one of these conditions, you probably already know about the risks. But it never hurts to be sure, so here’s the scoop.
High blood pressure (hypertension)
Blood pressure is the force exerted by your heart when it pushes blood out into your arteries. When your arteries are clear and clean, your heart has an easy job: The blood flows easily into the arteries, and your blood pressure is normal.
But if your arteries have been narrowed — perhaps by cholesterol plaque buildup on the inside walls — your heart must contract more strongly and push harder to get the blood out into the vessel. As a result, blood is pushed out of the heart at higher-than-normal pressure. The high-pressure stream of blood bouncing against arterial walls can worsen the damage caused by cholesterol and plaque. (The damage is called arteriosclerosis or “hardening of the arteries.”)
How can you tell if you have high blood pressure? Look at your blood pressure reading. You’ll see two numbers written like this: 130/90 or 130/90 mm/Hg. The first number, the systolic reading, is the pressure exerted by your heart when it contracts (beats) to pump out blood. The second number, the diastolic reading, is the force exerted by your heart between beats.
The letters mm/Hg stand for millimeters/mercury. (Hg is the chemical symbol for mercury.) These terms are part of the reading because your doctor measures blood pressure by how high (in millimeters) mercury rises on the little gauge attached to the blood pressure cuff wrapped around your arm. Reading the gauge is similar to reading the temperature on a thermometer as the mercury inside the thermometer’s glass tube rises or falls when warmed or cooled.
For years and years, doctors considered an adult’s blood pressure normal when the systolic reading was lower than 130 mm/Hg and the diastolic reading was lower than 90 mm/Hg (130/90), but the newest numbers from the experts at the National Institutes of Health now put normal at 120/80. And as with cholesterol, there are varying degrees of normal when it comes to describing blood pressure.
Table 3-6 shows the most recent categorization of blood-pressure levels from the National Institutes of Health, starting with optimal (translation: the best possible result), and running up (or down) through normal and high normal to the various stages of hypertension (higher than high, and potentially hazardous to your health).
If you already have high blood pressure, your doctor has no doubt told you about the basic strategies you can use to control it:
� Lose weight.
� Change your diet.
� Exercise.
� Take a pill.
Strangely enough, these steps sound just like the ways to control cholesterol. Think of them as a medical two-for-one coupon!
People with diabetes often have frighteningly high cholesterol levels. I’m not talking your piddling 240 mg/dL reading here. No, what I mean is a cholesterol level hovering around — hold your hat — 500 mg/dL.
People with diabetes also have high blood-levels of insulin, the hormone pro- duced by the pancreas and used to digest food. Yes, I know, you may have thought that people with diabetes have low levels of insulin. Actually, people with diabetes do produce less insulin than healthy people do, but they also have a problem using insulin to digest food, so the unused insulin continues to circulate in their blood until it is excreted from the body.
Type 2 diabetics are usually overweight adults. Being overweight leads to insulin resistance. Insulin resistance means that the cells in the body require a greater amount of insulin to push the glucose (sugar) into the cells so it can be used for energy. This is why they have higher levels of circulating insulin.
The best way to control diabetes? Lose weight, change your diet, exercise, and take your medicine. Good ways to control cholesterol? Lose weight (Chapter 7), change your diet (Chapter 4), and — sometimes — take your medicine (Chapter 12). Are you beginning to see a pattern here?
Previous heart attack
If you’ve already had a heart attack, you know your cholesterol numbers, and your doctor has probably already prescribed one of the cholesterol-lowering medications I talk about in Chapter 12. No need to dwell on this one.
No, you don’t have to be rail thin. No, you don’t have to spend your life on
a diet. Your body was created to be at a good weight for your size and shape. This weight may not be the same for you as for your best friend or that model over there in the who-is-she-kidding slinky dress or the painted-on swim trunks. Just turn to Chapter 7, which explains exactly how excess pounds raise your cholesterol level and how staying in reasonable shape or losing as few as 3 to 5 pounds can lower your cholesterol.
Are you a couch potato? Do you smoke? Shame on you! Don’t wait another minute — turn to Chapters 8 and 9. Read about the hazards of inactivity and smoking. You can decide to change these risk factors by the time you finish reading this sentence. So do it.
Heart Attack Risk Factors at a Glance
High LDLs and low HDLs are only two of the heart attack risk factors on the list compiled by the National Cholesterol Education Project, a group with more statistical information than you can shake a stick at. (I have no idea why anyone would want to shake a stick at these stats — or even what the saying means. Inquiring minds want to know!) Table 3-7 gives you a quick rundown on a whole bunch of risk factors. What a handy guide!
Westerners often turn shivery when they see the number 13. The number that spooks some Asians is 4. In Mandarin, Cantonese, and Japanese, the word for the number four sounds exactly like the word for death, a linguistic oddity that may have serious implications for some Asian-American heart attack victims.
A recent report in the British Medical Journal compared death statistics from 1973 to 1998 for more than 200,000 Asian Americans and 47 mil- lion White Americans living in the United States. The data shows that Chinese-American and Japanese-American heart attack victims who die of their heart disease are most likely to die on the fourth day of the month.
The highest number of fourth-day deaths occurred among hospitalized heart attack victims (versus people who had a heart attack at home or somewhere else). One possible conclusion is that the power of suggestion may play an important role in deciding whether a person survives a heart attack. Another possible conclusion is that being able to leave the hospital quickly after a heart attack increases the chances of survival.
By the way, there was no similar link between the 13th day of the month and the incidence of death among non-Asian heart attack patients, perhaps because the word thirteen doesn’t sound like death.
Checking for Plaque Buildup
A cholesterol blood test is definitely valuable because it tells you exactly where you stand, cholesterol-wise. But the test doesn’t tell you whether you already have plaque — the technical term for cholesterol deposits — in your arteries or whether the plaque deposits are serious enough to set a heart attack in motion. That’s a job for other tests specifically designed to determine the condition of your arteries. You can group these tests into two handy categories: blood tests and physical tests.
Blood tests
Blood tests are simple to do. Just stick out your arm and . . . well, if you’ve had your cholesterol tested, you know the drill.
Catching C-reactive proteins
C-reactive proteins (CRP) are substances released into your bloodstream when tissues, including the blood vessels leading to your heart, are damaged and inflamed. As a result, measuring levels of cardiac CRP in your blood can serve as a guide to the condition of your arteries and predict your risk of heart attack or stroke.
In 1998, a team of researchers from Brigham and Women’s Hospital and Harvard Medical School rated the risks linked to CRP levels in blood samples from nearly 40,000 healthy, post-menopausal female nurses participating in the legendary Nurses’ Health Study. The result? Women with the highest levels of CRP were five times more likely than women with very low levels to develop cardiovascular disease and seven times more likely to have a heart attack or stroke.
One year earlier, the Boston team noted similar results in an ongoing study of 22,000 healthy male doctors. These results led them to conclude that using “high-sensitivity” or “ultrasensitive” tests to measure cardiac CRP is a good way to “predict the risk of future heart attack and stroke events.” (Check out Chapter 8 for info on the connection between exercise and reducing CRP levels.)
Measuring MPO
White blood cells are the body’s natural defense against inflammation and infection. When the white blood cells sense trouble, they release myeloperoxidase (MPO), a protein that can knock the heck out of the bugs causing the inflammation and infection.
But MPO may also irritate arteries and short-circuit natural body chemicals that keep “bad” cholesterol particles from glomming on to artery walls, thus contributing to the buildup of plaque inside your blood vessels. In July 2007, the Journal of the American College of Cardiology published data from a study of more than 1,000 healthy Brits showing that, over the years, those with the highest blood levels of MPO had the highest risk of coronary artery disease (CAD).
In other words, high blood levels of MPO may signal artery trouble ahead, even when other indicators, such as LDL levels, are fine. Naturally, the researchers want to see more studies before they stick an MPO test onto your yearly lab tests, but, as one of the researchers said, “MPO looks like a ‘keeper’ that will one day become part of clinical care.”
Many insurance companies, including Medicare, may not pay for CRP or MPO blood tests because they argue that if you have elevated levels, you need to make all the necessary lifestyle changes (lose weight, treat high blood pressure, stop smoking, eat a healthy diet, and so on). You should be doing this anyway! However, sometimes demonstrating to people that their risk of a heart attack in the next five years is great can stimulate them to become more serious about making lifestyle changes.
Physical tests
You don’t stick out your arm for these tests; you warm up the muscles on treadmills and other such devices.
Stress tests
For a simple stress test, your doctor sticks electrodes on various parts of your anatomy, mainly your upper torso, and reads the results as you march on a treadmill or push the pedals on a stationary bike . . . No, no, no — come back. Electrodes aren’t needles. They’re round, flat gizmos that are “pasted” on to you with sticky fluid. The electrodes transmit electrical impulses to a machine. The machine then translates the impulses into numerical measurements of the flow of blood through your cardiovascular system as you do the treadmill or bicycle thing.
Sometimes a simple stress test delivers false positives (suggesting you have heart disease when you don’t) or false negatives (suggesting you’re risk-free when you’re not). For more accurate results, your doctor relies on a thallium stress test or sestamibi stress test.
The thallium or sestamibi stress test begins with an injection containing radioactive thallium or sestamibi. After the shot, your doctor asks you to wait for about three hours while the radioactive substance circulates through your blood vessels. Then you get fitted with electrodes, climb on the tread- mill or bike, and your doctor monitors your blood flow via those electrodes. Next you lie on a table while a special low-dose X-ray machine tracks the radioactive substance as it flows through your heart and blood vessels. As you can imagine, trouble spots — a narrowing here and buildup there — are clearly visible.
By the way, if you have a medical condition, such as arthritis, that makes it difficult for you to walk on the treadmill or ride the bike, your doctor can use a special medication called persantium, rather than exercise, to speed up your heartbeat and blood flow.
No, electron-beam-computed tomography (ECBT), sometimes called ultrafast CT, isn’t the machine that beams Captain Kirk up to the Enterprise. It’s an injection-free CAT scan that provides snapshots of your heart, lungs, and coronary arteries to uncover the presence of calcium deposits, a warning sign of plaque buildup in your arteries.
The ECBT is about seven times faster than a conventional CAT scan. The test, which takes about five minutes to run, is a super way to catch plaque problems very early or (think positively) to show that you’re plaque-free. Unfortunately, the test costs $300 to $500, and although doctors consider it basic medicine, some insurance plans haven’t yet adopted this view. Bummer.
Having an angiogram isn’t an everyday walk in the medical park. This proce- dure is reserved for people with chest pain or other signs of an imminent heart attack.
To perform the test, your cardiologist or radiologist (by this time, you’re way past the primary-care-physician stage) inserts a very small tube called a catheter into an artery, sends dye through the tube into your bloodstream, and watches an X-ray monitor to see how freely the dye flows. If the dye sud- denly slows or stops, blocked by a clot or narrowed area, your doctor may perform immediate angioplasty, the surgical procedure that removes the blockage and clears the blood vessel. In most cases, after clearing the vessel, the surgeon inserts a stent — a tiny spring — into the artery to hold it open, hopefully forever. The stent is designed to prevent restenosis, the technical term for blocking an artery after it has been cleared out. If the artery is blocked again, the treatment is a new angioplasty and a new stent.
In order to be able to do an angioplasty, the blockage must not be too far down the coronary artery or else the balloon won’t be able to fit in there. If you have multiple blocked arteries or an angioplasty can’t be performed, a cardiac surgeon can perform coronary bypass surgery whereby he takes arteries from one place in your body, such as the internal mammary arteries, and attaches them to your coronary circulation.
I certainly hope you never need an angiogram. But, if you do, the good news is that it can save your life and keep you alive for years and years to come, which gives you plenty of time to work on controlling your cholesterol.
Calculating Your Heart Attack Risk
Now you know all there is to know about the risk factors associated with high cholesterol and your risk of having high cholesterol. In this section, you can use all the info you’ve picked up to calculate your personal risk of having a heart attack in the next ten years.
The NCEP calculator
Luckily, you don’t have to be a calculus whiz to do the math. The National Cholesterol Education Project has created an interactive “Risk Assessment Tool for Estimating Your Ten-Year Risk of Having A Heart Attack.” You can find this tool at the following Web site: http://hp2010.nhlbihin.net/ atpiii/calculator.asp?usertype=pub.
On the online form, type in the appropriate numbers, click the proper boxes, and hit the appropriate button (the one labeled “Calculate Your Ten-Year Risk”). What you get back may surprise you. For example, my total cholesterol is high, but my HDLs are also high. My blood pressure is normal, and I haven’t smoked in years, so the calculator puts my ten-year risk of heart attack at 5 percent (meaning 5 of every 100 persons with my particular numbers will experience a heart attack in the next ten years).
Try it. You, too, may be pleasantly surprised at the answer. On the other hand, if your number is higher than you want, move on to the next section, a calculator with a point system.
A second numbers game
The multi-part Risk Predictor Score Sheet created by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health (NHLBI/NIH, for short), calculates the ten-year risk of heart attack by assigning specific points for the following six specific risk factors:
� Age
� Total cholesterol
� HDL cholesterol
� Blood pressure
� Diabetes
� Smoking
Because men and women have different bodies and, thus, different levels of risk, there are two score sheets based on gender:
� Women: www.nhlbi.nih.gov/about/framingham/risktwom.pdf
� Men: www.aafp.org/fpm/20040100/coronarydiseaserisk_ men.pdf
You can simply grab a pencil and walk through the following steps, which are as simple as one, two, three, four . . . or, more accurately, Table 3-8 all the way up through Table 3-12.
Follow these steps:
1. Score yourself from the following five tables. Yup. This is where the pencil pushing starts.
2. Add up your scores from Table 3-7, Table 3-8, Table 3-9, Table 3-10, Table 3-11, and Table 3-12 to get your total score.
Your total score:
3. Check your total against Table 3-13, which estimates your risk for heart disease in the next ten years due to blocked arteries.
For example, a man with a total point score of 9 has a 20 percent risk of heart attack in the next ten years. With a point score of 14 — where the count for men stops — the odds of his having a heart attack in the next ten years zoom all the way up to 53 percent. For a woman, the equivalent risks are 8 percent and 19 percent.
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