Extensive clinical and statistical studies have identified multiple factors that increase your risk for a heart attack or stroke (“brain attack”). Use this worksheet to determine your total number of risk factors. Desired cholesterol levels are based on your total number of risk factors.
Risk Factors: Check all that apply.
Male: 45 years or older.
Female: 55 years or older
____ Family history of premature coronary artery disease (CAD).
Definite heart attack, sudden death, or vascular procedure, such as angioplasty or bypass surgery before 55 years in a father or brother, or before 65 years of age in a mother or sister.
____ Current cigarette smoking.
____ Physical Inactivity.
____ Low HDL-cholesterol (< 35 mg/dl).
____ Triglyceride level over 200
____ Diabetes mellitus.
____ Obesity. Defined as Body Mass Index (BMI) over 30.
Subtract one risk factor for an HDL-Cholesterol over 60 mg/dl. (The “good” cholesterol. Congratulations if you have a high HDL!)
_____ TOTAL Risk Factors
Treatment is based on your LDL (“Bad Cholesterol”) level and your total number of risk factors for coronary artery disease. You will fall into one of the three following groups. It has been proven that aggressive treatment of elevated cholesterol levels, along with controlling all treatable risk factors, can lead to a regression of “hardening of the arteries” in some individuals.
_____ Group 1: No Known Heart Disease and 0-1 Risk Factors:
Treatment: Start a Low Cholesterol Diet if the LDL is over 160. Consider adding Drug Therapy if the LDL remains over 190. The target LDL is below 160.
_____ Group 2: No Known Heart Disease and 2 or more Risk Factors:
Treatment: Start a Low Cholesterol Diet if the LDL is over 130. Consider adding Drug Therapy if the LDL remains over 160. The target LDL is below 130.
_____ Group 3: Existing Vascular Disease
Treatment: Start a Low Cholesterol Diet if the LDL is over 100. Consider adding Drug Therapy if the LDL remains over 130. The target LDL is below 100.
Your diet is not always the main cause of lipid problems. These problems are frequently inherited and require medication to control. Even so, diet therapy should always be tried for 3-6 months before drug therapy is initiated (unless you are one of the very rare people who already have a perfectly healthy diet). Appropriate consultation with a nutritionist should even be considered before drug treatment is undertaken. Once started, however, drug therapy is usually continued for life.
A word about the Prevention of Coronary Artery Disease. Try to eliminate as many risk factors as possible. Additionally, the following measures seem useful in helping to reduce your risk for heart attack. Do not ever use any supplements or other medications unless cleared by your personal physician.
- Aspirin: Take between 81 and 325 mg. per day.
- Vitamin E: Take between 100 and 400 International Units (IU) per day.
- B-Complex Vitamins (Folate, B6, and B12): Help rid the body of an amino acid called homocysteine, which many researchers believe has a role in causing heart disease. Low B6 and B12 levels correlate with an increased risk of CAD.
Five servings of fruits and vegetables per day should provide enough folate and B6 levels to reduce homocysteine levels. Consider supplementation with 400 mcg. of folate per day and 2 mg of B6 per day if your diet falls short of these guidelines. Most multivitamin supplements will contain this amount.
- Selenium: Take no more than an additional 100 mcg. a day as a supplement. This mineral can cause some bothersome, or even dangerous, side effects if taken in excessive doses.
- Fish: The overall body of data does suggest that regular modest (6 ounces per week) fish intake might be beneficial for the heart.
There really is no substitute for the effectiveness (and downright common sense) of a healthy lifestyle and diet in preventing vascular disease and thus reducing the risk for heart attack and stroke. Supplements are not meant to be a substitute for a well balanced diet. Rather, as the name implies, they are meant to be a supplement to a well balanced diet.