What Is Your Cardiovascular Risk Score, and How Can You Improve It?

On a 100 point scale, how do you measure up?

[Category : Alive : longevity and an ounce of prevention]

The American Heart Association (AHA) has provided an update on 8 modifiable factors that we can use to quantify, and thereby hopefully improve, our cardiovascular health behaviors. It’s an interesting tool that you can plug your lifestyle and behavioral choices into, and then receive a score from 0-100 points. The higher the score, the healthier your predicted cardiovascular risk. The average score for Americans in a large study was 64, with women doing better than men (67 for women versus 62 for men). It’s not quite as fun as some of those quizzes that tell you which Harry Potter Hogwarts house you belong to, or which Star Wars character you might be. But the AHA quiz and personal score does have the potential to wake us up to some behaviors that could be improved for longevity.

So before taking the 8 question quiz, what do you think your score will be? The 8 risk factors for determing cardiovascular health are:

• diet

• physical activity

• nicotine exposure (including vaping and secondhand smoke)

• body-mass index

• blood lipids

• blood glucose

• blood pressure

• sleep duration

OK - so now that you’ve done the pretest, *here is a link to the actual quiz*. It takes about 5-10 minutes, so budget that time if you have to come back and do this later! Unfortunately you’ll have to click “Individuals can sign up here” which takes you to the next page where you create a free account with the American Heart Association by providing a name and email address.

If you don’t know your exact numbers for cholesterol, blood pressure, servings of vegetables per week, etc., I think it’s ok to use your best recollection/estimate. Or you can log on to your chart if your health system provides that, or dig through your most recent results by *gulp* calling your doctor’s office.

My score was pretty decent. The AHA provides a summary at the end on the factors that drove your score, and ways to improve it. I need more SLEEP, and maybe working on stress to reduce blood pressure.

In that large study mentioned above, among 24,000 subjects assessed with this tool, the worst risk scores in adults were found in the diet, physical activity, and body mass index categories.

Children’s diet scores were quite bad actually, which is a scary thought for the future, and is another reason to try to invest in healthy foods. When kids frown at broccoli and cod, it’s OK to say “this is what’s for dinner.” At some point an instinct for self-preservation kicks in, and cod starts to look like mashmallows. In children, diet scores were low (mean 40.6) and were progressively worse in older age groups (dropping from 61 for ages 2-5, down to 28 for ages 12-19)!

Why is this tool so timely and important?

According to a recent study in Journal of the American College of Cardiology out of Harvard:

“Millions more Americans are expected to develop cardiovascular disease (CVD) over the next few decades, according to projections.

Large increases in people with CVD are expected from 2025 to 2060 in line with changing demographics:

• Ischemic heart disease: 21.9 million to 28.7 million

• Heart failure: 9.7 million to 12.9 million

• Myocardial infarction: 12.3 million to 16.0 million

• Stroke: 10.8 million to 14.5 million

Moreover, by 2060, there will be 54.6 million Americans with diabetes, 162.5 million with hypertension, 125.7 million with dyslipidemia, and 125.7 million with obesity.”

Please Summarize the Risk Factors Again

The AHA has a good page on each modifiable risk factor, and I’ll quote the quick advice they give on each one:

• Diet - Aim for an overall healthy eating pattern that includes whole foods, lots of fruits and vegetables, lean protein, nuts, seeds, and cooking in non-tropical oils such as olive and canola.

• Physical activity - Adults should get 2 ½ hours of moderate or 75 minutes of vigorous physical activity per week. Kids should have 60 minutes every day, including play and structured activities.

• Nicotine - Use of inhaled nicotine delivery products is the leading cause of preventable death in the U.S., including about a third of all deaths from heart disease. And about a third of U.S. children ages 3-11 are exposed to secondhand smoke or vaping.

• Sleep duration - Most adults need 7-9 hours of sleep each night. Children require more: 10-16 hours for ages 5 and younger, including naps; 9-12 hours for ages 6-12; and 8-10 hours for ages 13-18. Adequate sleep promotes healing, improves brain function and reduces the risk for chronic diseases.

• Weight - Achieving and maintaining a healthy weight has many benefits. Body mass index, a numerical value of your weight in relation to your height, is a useful gauge. Optimal BMI is < 25. You can calculate it online or consult a health care professional.

• Cholesterol - High levels of non-HDL, or “bad,” cholesterol can lead to heart disease. Your health care professional can consider non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol, because it can be measured without fasting beforehand and is reliably calculated among all people.

• Blood sugar - Most of the food we eat is turned into glucose (or blood sugar) that our bodies use as energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves. As part of testing, monitoring hemoglobin A1c can better reflect long-term control in people with diabetes or prediabetes.

• Blood pressure - Keeping your blood pressure within acceptable ranges can keep you healthier longer. Levels less than 120/80 mm Hg are optimal. High blood pressure is defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

Blood pressure goals can feel pretty stressful, as the majority of people I see in the office, including very healthy ones, routinely come in >120/80. Home monitoring is better, as studies have shown blood pressure readings in the doctor’s office are usually higher because of anticipation, hurried walk back to the examining room, the white coat, etc. Here is a quick review on the stages of hypertension if you want some additional reading.

I realize that people will need some time to do this quiz, and the folowing post-test assessment might have many fewer responses, but I’ll throw up a poll anyway just for fun. Come back if you can. What was your score?

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In summary, I think this modifiable risk factor assessment tool put out by the AHA, and then recently applied to 24,000 people in a study published in a very respected journal, is a good way to start thinking about ways to improve our cardiovascular health. By simply taking 5-10 minutes to complete the quiz, we can reflect on our behaviors and choices in a way that we often don’t have time to do in an organized way. The AHA provides a lot of self-educational materials along the way, and by reading about your score you can do a deep dive on each of the 8 risk factors through resources they provide right there on the website. I plan to get more sleep, keep working on stress, and eat more broccoli. I’ll work on a marshmallow and cod recipe for kids. And now that you have a free account with the AHA, you can also come back and take the test later, and try to improve your score and cardiovascular health. What do you need to refocus on? Best of luck :)

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