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You should consider investigating certain supplemental risk factors if you have a family history of premature coronary heart disease or stroke (first degree relative affected before age 60), two or more of the traditional risk factors described above, or an above average ten year risk. These additional risk factors include anatomic markers of disease already present in arteries, certain inherited metabolic disorders and social/behavioral patterns which are not as extensively validated in large populations as the traditional risk factors discussed above. The actual risk they add to your traditional risk factor score above is uncertain. However, the risk of an abnormal test compared to an average risk for your age has been estimated in smaller studies and is expressed as a Risk Ratio (RR). From the Traditional Risk Factor Worksheet, look up the average risk of developing CHD for your age and multiply it by the risk ratio (RR) if one of these tests is abnormal. Thus, a 50-year-old man with a 14% risk of CHD over ten years has a 28% risk if Homocysteine is significantly elevated. Consult your doctor for the appropriateness of ordering these tests and interpretation of results. More information about each test is available in the Heart Disease Prevention Monograph on Advanced Risk Assessment. |
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Worksheet - Supplemental |
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Anatomic Markers of Athlerosclerosis Already Present
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Electron Beam CT Scan (EBCT) Coronary Calcium Score (RR = 2x)
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Normal score 0
- Mild plaque burden 1 - 100
- Moderate plaque burden 101 - 400
- Extensive plaque burden > 400
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Score ________ |
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Carotid Duplex Scan (RR = 2x)
- Presence of athlerosclerotic plaque
- Percent obstruction of plaque
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% ____________ |
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Blood Tests for Inhereted Metabolic Disorders
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Lipoprotein (a) (RR = 3x)
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Lp(a) __________ |
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Homosysteine (RR = 2x)
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Hc ___________ |
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LDL Subclass Pattern
- Pattern A - less athrogenic
- Pattern B - athrogenic
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LDL A: _____ B: _____
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C-Reactive Protein (hsCRP) (RR = Unknown)
- Normal < 0.22
- Use only the quantitive, highly sensitive assay method
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hsCRP __________ |
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Fibrinogen (RR = Unknown)
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FIB __________ |
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Social-Behavior Patterns that Increase Risk |
These patterns are difficult to measure and quantify. Nonetheless, when objectively assessed by questionnaire or standard assessment tools, they carry added risks equal to or greater than any of the traditional or supplemental risk factors listed above. These patterns are difficult to change. At the very least they identify individuals at higher risk who deserve special attention and extra effort at modifying treatable risk factors.
Relationships ?
Group support?
Depression?
Anxiety?
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