Are You At High Risk of Heart Attack Due to Your Past Medical History?

The Framingham Risk Assessment Tool (1) allows you to calculate your ten year risk of having a heart attack based on your age, sex, total cholesterol, hdl cholesterol, systolic blood pressure, whether or not you smoke, and whether or not you take high blood pressure medicine. You just go to the website (1) and fill in the numbers and hit calculate.

You will find your risk of a heart attack over the next ten years.

Persons are at high risk of their ten year risk is greater than 20% (meaning that more than 20 people out of every hundred in the group will have a heart attack over the next ten years).

Persons at intermediate risk have a risk of 10% to 20% (10 to 20 people of this group of 100 will have a heart attack over the next ten years).

Persons who are at low risk have less than 10% risk (fewer than 10 out of 100  of this group will have a heart attack over the next ten years).

However, the calculator is not all you need for risk assessment.

You need to answer yes or no to ten questions about your past medical history

1. Have you ever had a heart attack or stroke?

2. Do you have angina?

3. Have you ever had a transient ischemic attack (TIA)–also called a ministroke?

4. Have you ever had coronary artery bypass surgery or a coronary angioplasty or a coronary stent?

5. Have you ever had a carotid endarterectomy?

6. Have you ever had any other type of vascular surgery?

7. Have you ever had a vascular balloon angioplasty or stent placed in a blood vessel in the neck, abdoman or legs?

8. Do you have peripheral vascular disease?

9. Do you have an abdominal aortic aneurysm?

10. Do you have diabetes and are you over 40 years of age?

If you answered yes to any of the above questions then you are at high risk even if the risk calculator says that you are at low or intermediate risk.

And if you are at high risk you need work hard with your doctor (with healthy living habits and medicines) to lower that risk. Doing this can cut your risk by 40% or more.

One final question: Do you have a family history of premature heart disease (a son, father, or brother with heart disease before age 55 years or a daughter, mother, or sister with heart disease before the age of 65 years)?

If the answer to that question is yes then you are at intermediate risk even if the risk calculator says low risk.

For recommendations at each level of risk see Tables 2 and 3, pp 236 and 237 from
Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines (2004) available at

(1) Framingham Risk Assessment Tool at

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