Heart Assessment

Based on your answers, you are doing all you can to minimize your risk. It may still be beneficial to talk to your doctor about your individual risk factors so that you can stay ahead and work together on your health care.

Based on your answers, you could have a mild risk in developing health challenges. You may want to consider having a discussion with your physician at your next visit about your individual risks based off your health history.

Your answers indicate that you could be at an increased risk of developing health issues. You should bring these topics up with your doctor at your next visit and review your health plan together.

Your answers indicate you may have a moderate to elevated risk of developing health issues in the future. This may be a good time to schedule an appointment with your doctor and bring up any symptoms or concerns you may have regarding your health.

Your responses indicate that you could be at a high risk of developing health issues that could impact your well-being. You may want to consider scheduling an appointment in the very near future with your physician and address any concerns, symptoms, questions you may have.

*If you are experiencing any of the following symptoms, or feel that you are experiencing an emergency, please contact 911 and seek immediate help.

Heart Attack

• Chest discomfort
• Pain in the arms, back, neck, jaw or stomach
• Shortness of breath
• Breaking out in a cold sweat, nausea or light headedness

Stroke

• Face drooping or numbness
• Arm weakness
• Slurred speech

Your responses indicate that you could be at a very high risk of developing health issues that could impact your well-being. You may want to consider scheduling an appointment in the very near future with your physician and address any concerns, symptoms, questions you may have.

*If you are experiencing any of the following symptoms, or feel that you are experiencing an emergency, please contact 911 and seek immediate help.

Heart Attack

• Chest discomfort
• Pain in the arms, back, neck, jaw or stomach
• Shortness of breath
• Breaking out in a cold sweat, nausea or light headedness

Stroke

• Face drooping or numbness
• Arm weakness
• Slurred speech

Peripheral arteries are those that are away from the heart, such as in the legs, arms, head or stomach. PAD is when these arteries are narrowed by plaque buildup, thus restricting blood flow. Symptoms may include pain or tiredness in the leg or hip while walking or climbing stairs. However, sometimes there are no symptoms.

Source: American Heart Association

When artery blockages of peripheral artery disease become severe, the leg and especially the foot do not receive enough nutrition from the blood. This condition of critical limb ischemia may lead to amputation. Symptoms include blackened or painful cracks between the toes and sores that don’t heal.

Source: American Heart Association

Buildup of plaque in the arteries near the heart create coronary artery disease, which narrows the blood flow to the heart muscle. When untreated, the condition may lead to a heart attack. Risk factors include high LDL and low HDL cholesterol, high blood pressure, diabetes, smoking, family history, older than age 45 for men and post-menopausal women.

Source: American Heart Association

When the heart isn’t pumping enough to distribute blood and oxygen as needed, the condition is called heart failure. It is not a single event, and it develops over time, often following or together with other heart conditions. There are ways to manage heart failure with medication and lifestyle choices.

Source: American Heart Association

Also known as AFib or AF, atrial fibrillation is a type of arrhythmia (irregular heartbeat) that affects millions of Americans. While some people are aware of the feeling of a skipped heartbeat or a flutter, others do not have symptoms. The condition requires treatment to decrease the chance of complications such as stroke, blood clots or heart failure.

Source: American Heart Association

Smoking^2,3

• Over X4 risk of PAD

Hypercholesterolemia³

• X2 increased risk of experiencing claudication (leg pain associated with PAD)

Diabetes³

• 1.5 – 4-fold risk of developing PAD

Hypertension³

• 2.5 increased risk of experiencing claudication

Physical inactivity⁵

• Physical activity (at least x1 a week) significantly decreases the risk of developing PAD

Genetics⁶

• Ethnicity (black and American Indian) have been associated with higher prevalence of PAD
• Insufficient study on the relationship between family members with PAD their kids

Age⁴

• Risk increases with age, escalating significantly in those 70+

Smoking¹

• X4 risk of peripheral artery disease

Hypercholesterolemia⁶

• Undertreatment of Hypercholesterolemia leads to worse outcomes in CLI patients

Diabetes^3,7

• Increases mortality and risk of amputation
• Speeds up development from PAD → CLI

Physical inactivity⁹

• Lack of physical exercise increases the progression of developing CLI

Genetics

• Blacks and Americans Indians have significantly higher rates of CLI than others
• No studies on how family history affects CLI

Age⁸

• Greatest risk from 75+
• Ages drop at 85+ due to high mortality

Smoking¹

• X4 risk of peripheral artery disease

Hypercholesterolemia¹²

• Elevated LDL can increase risk of CAD by promoting the creation of plaque on artery walls

Diabetes¹¹

• Major risk factor → higher prevalence of heart attack in those with diabetes, than those without

Hypertension¹⁰

• People who consistently have blood pressures higher than 140/90
• Fatal CAD is higher in people with elevated blood pressures

Physical inactivity¹¹

• Results in low grade inflammation leading to increased plaque in coronary walls

Genetics⁴

• 50% increased risk of developing CAD with family history of premature angina or heart attack
• South Asians have over double (2.4) the chance of being hospitalized for CAD than whites.¹⁹
• Higher rates of CAD-related mortality than whites in the US.¹⁹

Age⁴

• Increases with age, with a significant increase in those 60+

Smoking⁴

• Responsible for 52% of heart failure in the US
• Coronary artery disease (high cholesterol has no direct link to HF)

Diabetes⁴

• Doubles risk of HF

Hypertension^13,4

• Increases risk of development as well as mortality

Physical inactivity⁴

• Living an active life is associated with a lower life-time risk of developing HF

Genetics⁴

• Direct family history of heart failure increases your risk of developing HF earlier in life
• Blacks have a higher proportion for developing HF compared to whites. (68% vs. 49%)
• Risk by race: Blacks, Hispanics, whites, Chinese Americans.

Age⁴

• Significant jump in heart failure prevalence in people 60+

Smoking¹⁴

• X2 increased risk for developing Afib in current smokers

Hypercholesterolemia

• Low HDL (good cholesterol) is associated with an increased risk of atrial fibrillation in women. 28% higher risk of developing Afib with each 10% decrease in HDL

Diabetes¹⁵

• 39% increased risk for developing Afib in people with diabetes

Hypertension¹⁶

• Hypertension is more present in Afib than other risk factors
• 60%-80% of all Afib patients have hypertension
• X2 risk in people with elevated BPs (>150 systolic)

Physical inactivity¹⁷

• There is inconclusive evidence suggesting that physical inactivity is associated with an increased risk of Afib

Genetics⁴

• Whites have the highest rates of Afib compared to other racial and ethnic groups

Age

• Large jump in Afib incidence in people +70 years old

1. Cleveland Clinic: https://my.clevelandclinic.org/health/articles/17488-smoking
2. US Department of Health and Human Services. Peripheral Artery Disease. https://www.nhlbi.nih.gov/health-topics/peripheral-artery-disease
3. Olin, A. Sealove, B. (2010). Peripheral Artery Disease: Current Insight into the Disease and It’s Diagnosis and Management. Circulation.
4. American heart Association (2019). Heart Disease and Stroke Statistics – 2019 update.
5. Stein, R. et al. (2015). Association between Physical Activity and Peripheral Artery Disease and Carotid Artery Stenosis in a self-referred population of 3 million adults. Journal of Arteriosclerosis Vascular Biology.
6. Liistro, F. et al. (2013). Impact of critical limb ischemia on long-term cardiac mortality in diabetic patients undergoing percutaneous coronary revascularization. Diabetic Care.
7. Freisinger, E. et al. (2017). Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardio Vascular Diabetology.
8. Baser, O. et al. (2013). Prevalence, Incidence and Outcomes of Critical Limb Ischemia in the US Medicare Population. Vascular Disease Management.
9. Olin, J. (2015). Peripheral artery disease: evolving role of exercise, medical therapy and endovascular options. Journal of the American College of Cardiology.
10. Rosendorff, C. et al. (2015). Treatment of Hypertension in Patient with Coronary Artery Disease. Circulation.
11. Leon, B. (2015). Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World journal of diabetes.
12. Gulati,M. (2018). Cholesterol factors and heart disease risk. American College of Cardiology.
13. Messerli, F. Rimoldi, S. Bangalore, S. (2017). The Transition from Hypertension to Heart Failure: Contemporary Update. Journal of the American College of Cardiology.
14. Chamberlain, A. Agarwal, S. Folsom, A. Duval, S. Soluman, E. Ambrose, M. Eberly, L. Alonso, A. (2011). Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm.
15. Bohne, L. Johnson, D. Rose, R. Wilton, S. Gillis, A. (2019). The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights. Frontiers in Physiology.
16. Verdecchia, P. Angeli, F. Reboldi, G. (2018). Hypertension and Atrial Fibrillation. Circulation Research
17. Ofman, P. et al. (2013). Regular physical activity and risk of atrial fibrillation. Circulation.
18. Rokkedal Nielsen, J. et al. (2013). The relationship between physical activity and risk of atrial fibrillation – a systematic review and meta-analysis. Journal of Atrial Fibrillation
19. Santos Volgman, A. et al. (2018). Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors and Treatments: A Scientific Statement from the American Heart Association. Circulation.