Heart Risk Calculator and Modifiable Risk Factors

[jerry1978]

(1)  Concerning the Framingham 10-year Heart Risk Calculator, is it still viewed as an accurate screening tool, given all the other advances in heart disease prevention that has evolved since the Framingham study?

(2)  Although all of the modifiable risk factors, as a whole, are important, how would you rate the following risks, beginning with the most important, for the prevention of heart attack.
a) smoking
b) uncontrolled hypertension
c) diabetes
d) lipid control
e) stress
f) weight control
g) excercise

Thanks, Jerry

[CCF-M.D.-MJM]

Hi Jerry,

1. The Framingham risk predictor is still a very good tool.  Other tools can be used to help predict future risk as well, but that doesn’t take away from the Framingham data.

2. That is a very tough question but I have been asked similar questions before.  People usually do no like my answer.  Modifiable risk factors are modifiable and should be approached as such.  Many people view risk factors as an ala care’ menu:  I will stop b-d but will continue a and e.  If you are really at risk (or in my mind, everyone) you should maximize all risk factor modification through aggressive medical and behavioral changes.  Besides, many of these risk factors are inter-related.  Obesity worsens hypertension and diabetes.  Exercise helps people lose weight, control diabetes, and hypertension.  Smoking makes it more difficult to exercise and breath.

The key is living a heart healthy life.  No smoking, watch your diet and exercise.  These three will help the hypertension, lipids, and diabetes.  What ever cannot be managed with diet and exercise should be treated aggressively with medications.

To me, ranking modifiable risk factors is like ranking the answer to a math question:  is 1+1    a: 4,  b: 5,   c: 11.  The right answer was not among the choices.  It is actually a combination of all of the choices 11-4-5 = 2.

I hope this helps.

[knicks30]

anybody know where i can take that 10 year test??

[Momto3]

Go to www.mayoclinic.com
Click on "Heart" on the left side of the screen
Scroll down to "Tool: Heart Disease Risk Calculator"

Let me know if that doesn't work for you and I'll get the direct link.  Good luck!!

[jerry1978]

There are also some variations on the Risk Calculator-some of the tests are modified to take into account BP, Diabetes, etc....
Best thing to do is a Google search with the words "heart risk calculator", and you'll come up with several different links.

[wesly]

Sorry if i am posting in the wrong area, but I am 42 years old and have earlobe creases.  This site says its link to heart disease is a myth, yet many other sites say it is a major indicator.  Does anyone know what the latest theory is?

[FredZ]

Don't know about the latest theory on ear lobe creases and heart disease. I first saw that theory in 1984. I see the beginnings of a crease in my left earlobe in pictures of me as a teenager. I'm now 60 and no sign of heart disease but well developed creases in each earlobe. I have personally known people with unlined and plump healthy looking earlobes who have departed this earth early--like early 50's--from a heart attack. So I don't worry a bit about it.

[CCF-M.D.-MJM]

I am copyied a table from the INTER-HEARTINTERHEART study by Salim Yusuf.  The numbers represent the increased risk of baseline risk without that risk factor....in otherwords, if smoke, you have a 2.95x increased risk.  Note that all risk factors combined add to a 129x increased risk, MUCH greater than any single risk factor alone.  That is why is important to attack the whole problem, all its components, rather than choosing which ones to change.  Good luck.



Risk factor
Odds ratio adjusted for age, sex, and smoking (99% CI)
Odds ratio adjusted for all (99% CI)

ApoB/ApoA-1 (fifth quintile compared with first)
3.87 (3.39-4.42)
3.25 (2.81-3.76)

Current smoking
2.95 (2.72-3.20)
2.87 (2.58-3.19)

Diabetes
3.08 (2.77-3.42)
2.37 (2.07-2.71)

Hypertension
2.48 (2.30-2.68)
1.91 (1.74-2.10)

Abdominal obesity
2.22 (2.03-2.42)
1.62 (1.45-1.80)

Psychosocial
2.51 (2.15-2.93)
2.67 (2.21-3.22)

Vegetable and fruits daily
0.70 (0.64-0.77)
0.70 (0.62-0.79)

Exercise
0.72 (0.65-0.79)
0.86 (0.76-0.97)

Alcohol intake
0.79 (0.73-0.86)
0.91 (0.82-1.02)

All combined
129.2 (90.2-185.0)
129.2 (90.2-185.0)