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Question: What are the most important cardiovascular disease risk factors?
Answer:
The risk of developing cardiovascular disease increases with age. All things being equal, a 60-year old has a higher risk than a 35-year old. Your age is not a modifiable risk factor.
Throughout their lifetime, men are at higher risk of cardiovascular disease than women. Your sex is not a modifiable risk factor.
Total cholesterol is a measure of the circulating fat in your bloodstream. Among its components are high density lipoproteins (HDL), low density lipoproteins (LDL), and triglycerides. Medical research has demonstrated that reducing total cholesterol will reduce the risk of developing cardiovascular disease. Elevated total cholesterol is a modifiable risk factor.
LDL is known as the "bad cholesterol" which can build up in your blood vessels over time and accelerate the atherosclerosis process. LDL cholesterol can be reduced with a low fat diet, weight loss, and medication. Elevated LDL cholesterol is a modifiable risk factor.
HDL is known as the "good cholesterol". The higher your HDL cholesterol, the lower your risk of developing cardiovascular disease. Factors that may lower your HDL include cigarette smoking, severe obesity, physical inactivity, and some medications. Maintaining an ideal body weight, staying away from cigarettes, and regular physical activity will maximize your good cholesterol level. A low level of HDL cholesterol is a modifiable risk factor.
The ratio of total cholesterol to HDL cholesterol in your body is one of the best lipid indicators of cardiovascular risk; the lower the ratio, the lower the risk. A ratio of 3.00 to 4.50 is common for women and 3.50 to 5.00 for men.
Blood pressure is an indication of how much your heart has to strain to circulate the blood throughout your body. Factors that raise your blood pressure include obesity, dietary salt, and physical inactivity. Hypertension can be treated by exercise, weight loss, salt restriction, stress reduction, and medications. Elevated blood pressure is a modifiable risk factor.
On average, smoking cigarettes reduces your life expectancy from 2 to 5 years. If you stop smoking cigarettes your cardiovascular risk will return to that of a non-smoker after approximately four years. It should also be noted that cigarettes are a major risk factor for many types of cancer and approximately ten years after you quit smoking your cancer risk will return to normal as well. Cigarette smoking is a modifiable risk factor.
Hyperglycemia is an elevation of the sugar in your blood. Diabetes is diagnosed when the blood sugar is consistently higher than normal (fasting plasma glucose (FPG) ≥ 7.0 mmol/L, casual plasma glucose ≥ 11.1 mmol/L, or an oral glucose tolerance test ≥ 11.1 mmol/L). Blood sugar can be reduced by a careful diet, maintaining a lean body weight, physical activity, and medications when necessary. Some research suggests that hyperglycemia may be a modifiable risk factor.
If one or more of your parents, brothers, or sisters has developed cardiovascular disease before the age of 60, you are considered to have a family history of premature cardiovascular disease. While this may be important in determining your overall risk of developing cardiovascular disease at an early age, it may not be as bad as it sounds. On average, a family history of premature cardiovascular disease doubles your overall risk of cardiovascular disease but it is impossible to determine whether or not you have inherited all the genetic factors that may have played a role in your family member developing cardiovascular disease. Your family history is not a modifiable risk factor.
Physical fitness through regular aerobic activities can reduce your risk of cardiovascular disease. Regular exercise can also lower your total serum cholesterol, blood pressure, blood sugar, and raise your HDL cholesterol. Aerobic fitness results from regular exercise of at least 30 minutes in duration, three or more times a week. Examples include brisk walking, jogging, cycling, swimming, dancing, and competitive sports. Sedentary individuals have double the cardiovascular disease risk of those who are physically fit. Physical inactivity is a modifiable risk factor.
Maintaining a healthy weight is beneficial not only to prevent cardiovascular disease, but also to help prevent diabetes. Your body mass index (BMI) is one measure of obesity. It compares your weight to your height (kilograms per meter squared). You should aim at a BMI no greater than 25. Having excess weight in the abdominal area is also a risk factor and you should aim at an abdominal circumference no greater than 102 cm (40 in.) for men and 88 cm (35 in.) for women. Individuals with a BMI greater than 35 or those with a BMI greater than 25 who also have a waist circumference greater than 94 cm* (37 in.) for men or 80 cm (32 in.) for women have an increased risk of cardiovascular disease, hypertension, and diabetes.
* 90 cm (36 in.) for men from South Asia, China, Central America, and South America.
Question: My cousin suffers from diabetes. Does it fall under the definition of family history of diabetes?
Answer: No. It has to be immediate family (parents and/or siblings) to be considered a family history of diabetes.
Question: I had gestational diabetes during my 2 pregnancies. Should I answer “yes” to the diabetes question?
Answer: No, but those who have a history of gestational diabetes are at increased risk of developing diabetes.
Question: My doctor told me that I have glucose intolerance. Should I answer “yes” to the diabetes question?
Answer: No, but individuals who have glucose intolerance are at higher risk of developing diabetes in the near future. You should try to get your blood sugar under better control through increased exercising and/or weight loss. Consult the “Stages of change” sections of this Web site on exercise and weight loss.
Question: Should people who smoke pipes or cigars be considered smokers or non-smokers on the risk profile?
Answer: The Cardiovascular Life Expectancy Model uses data from The Framingham Study (US Dept of Health, Education, and Welfare 1987. Publication NIH 87-2284), which specifically classifies people as smokers only if they smoke cigarettes. Pipe and cigar smokers may not have as high a risk for CVD as cigarette smokers but their risk appears to be elevated above that of non-smokers (J Chron Dis, 1978;31:201-311). Accordingly, you might want to classify heavy pipe or cigar smokers who inhale, as smokers on the user data sheet. Clearly, your judgement is required.
Question: There are various degrees of smokers. How does the model account for the difference between a person who smokes 40 cigarettes per day versus 6 cigarettes per day?
Answer: The model is based upon an average cigarette intake of 1 pack per day. If an individual smokes more or less, then the profile needs to be interpreted accordingly. It would be nice to include the number of cigarettes smoked, however, data has shown that individuals do not report this accurately.
Question: Why do some people have a 10-year coronary risk that is above average while their Cardiovascular Age is less than their chronological age?
Answer: The 10-year coronary risk estimates the risk of heart attacks and fatal coronary events. Cardiovascular Age includes the coronary events listed above plus the risk of non-coronary death (stroke, cancer, pulmonary disease, etc.). These non-coronary causes of death are also modified by three specific risk factors, namely smoking, blood pressure, and diabetes, but not cholesterol. Accordingly, the coronary risk factors used in the computer model have different effects on 10-year coronary risk and Cardiovascular Age. While these two parameters are usually both high (or low) in a specific patient, there are occasional mismatches.
Question: Why is there a discrepancy between the baseline risk percentages of the risk profile and the status/history report?
Answer: The discrepancy between the baseline risk percentages occurs because all risk calculations are based on the individual’s current age. If an individual has aged between the time of the initial risk profile and the status or history report, then all previous risk values are recalculated based on the individual’s current age. Age is a major risk factor and as an individual gets older, his/her cardiovascular risk becomes higher, therefore, it is necessary to use current age to be able to make comparisons over time.
Question: Why is it that a person with diabetes may still have a higher Cardiovascular Age than their actual age even after having significantly modified their risk factors?
Answer: Diabetes is a major risk factor and has a big impact on life expectancy which is reflected by the Cardiovascular Age. Even if other risk factors are well controlled, life expectancy is often still reduced. Diabetes is such an important risk factor that current guidelines consider individuals with diabetes to be at very high risk along with individuals who already have cardiovascular disease. The importance of this risk factor is not always reflected in the 10-year (short-term) risk. Therefore, the focus of the profile interpretation for users with diabetes should be on the Cardiovascular Age.
Question: What are the most important diabetes risk factors?
Answer:
HDL is known as the "good cholesterol". The higher your HDL cholesterol the lower your risk of cardiovascular disease. Factors that may lower your HDL include cigarette smoking, severe obesity, physical inactivity, and some medications. Maintaining an ideal body weight, staying away from cigarettes, and regular physical activity will maximize your good cholesterol level. A low level of HDL cholesterol is a modifiable risk factor.
Blood pressure is an indication of how much your heart has to strain to circulate the blood throughout your body. Factors that raise your blood pressure include obesity, dietary salt, and physical inactivity. Hypertension can be treated by exercise, weight loss, salt restriction, stress reduction, and medications. Elevated blood pressure is a modifiable risk factor.
Hyperglycemia is an elevation of the sugar in your blood. Diabetes is diagnosed when the blood sugar is consistently higher than normal (fasting plasma glucose (FPG) ≥ 7.0 mmol/L, casual plasma glucose ≥ 11.1 mmol/L, or an oral glucose tolerance test ≥ 11.1 mmol/L). Blood sugar can be reduced by a careful diet, maintaining a lean body weight, physical activity, and medications when necessary. Some research suggests that hyperglycemia may be a modifiable risk factor.
If one or more of your parents, brothers, or sisters has developed diabetes, you are considered to have family history of diabetes. In addition, people belonging to specific ethnic groups such as Aboriginal, Hispanic, Asian, South Asian or African descent have a higher risk of developing diabetes. However, it is impossible to determine whether or not you have inherited all the genetic factors that may have played a role in your family member's condition. Your family history is not a modifiable risk factor.
Regular physical activity can reduce your risk of diabetes by helping maintain a healthy weight, regulating your blood sugar metabolism, and decreasing your risk of heart disease through improved blood pressure and blood cholesterol levels. Aerobic fitness results from regular exercise of at least 30 minutes in duration, three or more times a week. Examples include brisk walking, jogging, cycling, swimming, dancing, and competitive sports. Physical inactivity is a modifiable risk factor.
Maintaining a healthy weight is beneficial not only for diabetes but for other diseases such as heart disease. Your body mass index (BMI) is one measure of obesity. It compares your weight to your height (kilograms per meter squared). You should aim for a body mass index (BMI) no greater than 25. Having excess weight in the abdominal area is also a risk factor and you should aim at an abdominal circumference no greater than 102 cm (40 in.) for men and 88 cm (35 in.) for women. Individuals with a BMI greater than 35 or those with a BMI greater than 25 who also have a waist circumference greater than 94 cm* (37 in.) for men or 80 cm (32 in.) for women have an increased risk of cardiovascular disease, hypertension, and diabetes.
* 90 cm (36 in.) for men from South Asia, China, Central America, and South America.
Question: My uncle suffers from diabetes. Does it fall under the definition of family history of diabetes?
Answer: No. It has to be immediate family (parents and siblings) to be considered a family history of diabetes.
Question: What is the ideal value for waist circumference?
Answer: An ideal waist circumference is less than 88 cm (35 in.) for women and less than 102 cm (40 in.) for men.
Question: Why is my waist circumference measurement value different from my pant size?
Answer: Depending on fashion, style, comfort issues, and physical morphology, pants are not necessarily worn at the level where the waist measurement should be taken. Men should measure their waist circumference at the navel and women midway between the bottom of the ribs and the top of the hip bones.
Question: I had gestational diabetes during my 2 pregnancies. Should I answer “yes” to the diabetes question?
Answer: No, but those who have a history of gestational diabetes are at increased risk of developing diabetes.
Question: My doctor told me that I have glucose intolerance. Should I answer “yes” to the diabetes question?
Answer: No, but individuals who have glucose intolerance are at higher risk of developing diabetes in the near future. You should try to get your blood sugar under better control through increased exercising and/or weight loss. Consult the “Stages of change” sections of this Web site on exercise and weight loss.
Question: What does “Cardiometabolic Profile” mean?
Answer: Cardiometabolic refers to cardiovascular disease and diabetes. The Cardiometabolic Profile is a two-page assessment evaluating your risk of having a cardiovascular event over the next ten years and your risk of developing diabetes over the next six years.
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