Cardiac Risk Assessment

Study each risk factor below and circle the most appropriate score for yourself. Add your
scores together for an indication of your cardiac risk.
Heredity
Do you have a father or brother who No 0
had heart disease before age 55, or a Yes (1 in family) 3
mother or sister with heart disease Yes (> 1 in family) 4
before age 65?
Age / Gender
Are you a male 45 years of age or older, No 0
or a female 55 years of age or older? Yes 4
Cigarette smoking
Never smoked 0
Ex-smoker 1
Smoke 1-20 cigarettes/day 2
Smoke 21-40 cigarettes/day 3
Smoke > 41 cigarettes/day 4
Systolic blood pressure
Your systolic blood pressure is < 120 mmHg 0
121 – 129 mmHg 1
130 – 139 mmHg 2
140 – 149 mmHg 3
> 150 mmHg 4
Total cholesterol
Your total cholesterol is < 5.2 mmol/L 0
5.2 – 5.7 mmol/L 1
5.8 – 6.2 mmol/L 2
6.3 – 6.8 mmol/L 3
> 6.9 mmol/L 4
Physical inactivity
How often do you engage in physical 5 or more times per week 0
exercise that increases your breathing 3-4 times per week 1
and heart rate, makes you sweat, for at 2 times per week 2
least 30 minutes a day? 1 time per week 3
Never 4
Obesity
How would you rate your body weight? Close to ideal 0
5 – 10 kg overweight 1
10 – 20 kg overweight 2
20 – 45 kg overweight 3
> 45 kg overweight 4
Stress
How would you describe the levels of Low to moderate levels of stress 0
stress you experience? High stress, but able to cope 1
High stress and unable to cope 2
Very high stress, but trying to cope 3
Very high stress and unable to cope 4
Diabetes
Have you been diagnosed with diabetes No 0
by a doctor? Yes 4
TOTAL = 5
Classification (circle):
Very low risk: < 5 Moderately high risk: 11 – 15* Very high risk: > 20*
Low risk: 6 - 10 High risk: 16 – 20* * make changes to reduce