A POST TO TAKE TO HEART!
One of the processes we use as part of the stages toward exercise testing and exercise prescription is health assessment. As part of a person's health assessment we can use knowledge of prime risk factors for future cardiovascular disease (CVD) to risk stratify a person's risk level of experiencing cardiovascular disease in their future.
The person's future risk level for CVD depends on factors that increase the chances of CVD occurring vs factors that decrease the chances of CVD occurring. We further distinct between prime risk factors to non-prime risk factors. A prime risk factor is a major cause for future CVD, proven by research to be as such.
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While multiple risk factors may exist for CVD, we identify eight positive prime risk factors (PPRFs) that increase the chances of CVD occurring, making these factors a bad thing that we don't want people having. There is one negative prime risk factor (NPRF) for CVD that decreases the chances of CVD occurring, making it a good factor that we want people to have.
The risk level (balance) of a person experiencing future CVD is calculated by subtracting their NPRFs (one possible exists) from their PPRFs (up to eight exist). Thus, the next process is to identify how many PPRFs and NPRFs a person has. Let's learn how to identify the prime risk factors, count them into the balance or not, and then learn how we interpret the outcome (what to say; what absolutely not to say).
PPRFs include a person's age; smoking habits; blood pressure; glucose and hemoglobin A1C levels; blood tissue total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL); body mass index (BMI) or waist circumference; physical inactivity; and family history.
If a woman 56 years of age or older OR a man 46 years of age or older, it increases their chances of future CVD and counts against them as a PPRF. A person currently smoking and/or has smoked in the last six months and/or is a second hand smoker, increases their chances of future CVD and counts against them as a PPRF.
If a person has a systolic blood pressure (SBP) of more than 130 mmHg and/or diastolic blood pressure (DBP) of more than 80 mmHg and/or being subscribed blood pressure lowering medications, it increases their chances of future CVD and counts against them as a PPRF, as they meet the medical criteria for a diagnosis of hypertension (HTN).
If a person's fasting blood glucose (FBG) levels are more than 126 mg/dL or their hemoglobin A1C (HbA1C) is greater than 6.5% and/or being subscribed blood glucose and/or HbA1C lowering medications, it increases their chances of future CVD and counts against them as a PPRF as they meet the medical criteria for a diagnosis of diabetes.
A total cholesterol (TC) of more than 200 mg/dL and/or HDL lesser than 40 mg/dL and/or LDL greater than 130 mg/dL and/or being subscribed lipid lowering medications, increases their chances of future CVD and counts against them as a PPRF as they meet the medical criteria for a diagnosis of dyslipidemia.
A person's body mass index is the mathematical ratio between their body weight and their height squared (to the second power). A BMI greater than 30 Kg/m2 and/or a waist circumference of 102 cm (40.15 inches) for a men and 88 cm (36.64 inches) for a women, increases their chances of future CVD and counts against them as a PPRF as they meet the criteria for a diagnosis of obesity.
The American College of Sports Medicine (ACSM) defines a person as "active" if they have been exercising for at least the last three months, at least three times per week, at least 30 minutes per exercise session, at least at moderate intensity (known as the 3-3-30-M rule). A person that does not meet all four criteria for being considered active, is considered inactive, increasing their chances of future CVD and counts against them as a PPRF.
A person that has a first degree relative that has experienced sudden death and/or a heart attack and/or coronary surgery if they were 1) A woman younger than 65 years of age or 2) A man younger than 55 years of age, increases their chances of future CVD and counts against them as a PPRF.
To clarify, a first degree relative must have a genetic connection to the person via at least one biological parent. Thus, the list includes biological parent, biological children, half brothers, and half sisters. It does not include adopted family, step parents, nor step children.
The only prime risk factor that is considered as a major factor that decreases the risk for future CVD is a high level of high density lipoproteins (HDL) of more than 60 mg/dL. A person that has high levels of HDL reduces the chances of future CVD and it counts in their favor as a NPRF.
Before calculating the person's balance, it is important to remember that while stratifying the risk for future CVD, we do not "double dip". Thus, in PPRFs with more than one criterion, it is enough to meet one of the criteria, for it to count as a PPRF increasing the chances of future CVD. For example, in regards to dyslipidemia, there are four possible criteria, yet if you meet one of them, it is enough to be diagnosed with dyslipidemia.
In regard to hypertension, it is enough that either your SBP or your DBP is above the criterion indicated above, to be diagnosed with hypertension. And so on, and so forth. Accordingly, a person's balance between PPRFs (bad for you) and NPRFs (good for you) ranges from -1 to +8. The best balance (sought out) is when a person has no PPRFs and enjoys the one possible NPRF (high HDL). Since a person's balance is calculated as the number of PPRFs minus the number of NPRFs, this person's balance will be (0 - 1) = -1 (the best possible).
A person at the highest risk for future CVD will have all 8 PPRFs and no NPRF. Thus, their balance will be calculated as (8-0) = +8. Obviously, a person's balance can be between -1 and +8. The higher the number, the greater the chances of experiencing future CVD.
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Lastly, this is only an estimation of the risk for future CVD occurrence. Thus, it would be a horrible mistake to calculate the chances (%) of CVD occurring or even daring to estimated, GOD forbid, actually determining exactly when they will have CVD or die.
Accordingly, we explain to people that the higher the balance, the greater the risk level they are at for future CVD, and we explain to them how they can lower their specific risk.
Out of the 8 PPRFs, two cannot be influenced in any way - a person's age and a person's family history. That is way lowering the risk for CVD focuses on the other 6 PPRFs that can be influenced by life choices and lifestyle changes. You can choose to become active and fit; You can choose to change your diet; You can choose to stop smoking and/or avoid smokers. These proactive measure will lower your risk for future CVD partially or completely.
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