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Guidelines on Assessing the Risk for Heart Attack and Stroke: What You Need to Know

Guidelines from the American Heart Association and the American College of Cardiology were released on November 12, 2013.

Stroke Added As Predictor For Cardiovascular Disease

For the first time, the guidelines added stroke to the equations for predicting future risk of cardiovascular disease. This is a welcome change, especially since recent studies have shown that women, in particular, often suffer a stroke rather than a heart attack as their first consequence of cardiovascular disease.

The guidelines emphasize looking at a person’s risk of a heart attack or stroke within the next 10 years. The risk is calculated using the following factors: age, sex, race, total cholesterol and high-density lipoprotein (HDL—the “good” form of cholesterol), blood pressure and control of high blood pressure, diabetes and whether the person is a current smoker.

Putting Risk Factors in Perspective

  • The guidelines emphasize chronological age; however, people age differently and “health age” may not correlate with chronological age.
  • The guidelines do not take into account family history of early heart disease, which may increase a person’s risk. However, the committee recommends looking into family history if there is uncertainty about treatment decisions.
  • A computed tomography (CT) scan to see if the person has evidence of coronary artery calcium can be a tie-breaker for helping to decide if a person should start statin medication therapy.
  • If a person recently diagnosed with diabetes has normal cholesterol levels and a hemoglobin A1C measurement of less than 7.5 percent, then a coronary calcium scan can also help determine whether statin therapy should be started.
  • Other tests that can help with decision-making about statins include a blood test for C-reactive protein (a marker for inflammation) and an ultrasound to assess blockages in leg arteries.

Know Your Cardiovascular Disease Risk

Roger S. Blumenthal M.D., director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, discusses new guidelines for assessing the risk of cardiovascular disease and choosing treatment strategies to prevent heart attack and stroke.






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