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Am I at High Risk for a Heart Attack?

Q. How do physicians assess a patient’s risk for heart attack, and what factors are taken into consideration? After 20 years of resisting medication and being told my cholesterol numbers were so off the chart I was at extreme risk for a heart attack, I was told at my last checkup that my 10-year risk for a heart attack was only 9 percent.

A. Physicians use a number of different factors to assess your risk of having a heart attack or stroke, including your age, gender, race, total cholesterol and levels of so-called “good” HDL and “bad” LDL cholesterol. Whether you have high blood pressure or diabetes and whether you smoke are also important risk factors.

Though your level of “bad” cholesterol is a very important risk factor, “the need for a cholesterol-lowering statin is not based solely on the LDL level, but on the other risk factors it keeps company with,” said Dr. Robert Eckel, a former president of the American Heart Association.

Weight, physical activity and diet also play a role in heart disease, though they aren’t usually included in heart risk calculators that you find online and that physicians utilize to assess risk, from groups like the American College of Cardiology. (Some heart risk calculators you’ll find online have been criticized for overestimating the risk of heart disease, but they can give you a rough idea of where you stand, as long as you’ve had your cholesterol and blood pressure tested recently).

The estimation of risk can change based on a single factor. So, for example, while a 50- or 60-year-old woman with high LDL cholesterol but no other problems may face a very low risk of a heart attack or stroke over the next 10 years, a man of the same age with a similar profile will be at considerably higher risk. Advancing age increases the risk for both men and women.

That said, if your 10-year risk of developing cardiovascular disease is assessed at 9 percent, you should consider medical treatment. Current medical guidelines recommend starting nondiabetic patients ages 40 to 75 on statins once their 10-year risk for cardiovascular disease is 7.5 percent or higher.

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