Indicate the points that you have scored in the column on the right for each of the following risk factors. When you finish, total your points and compare that with the results at the end of the activity.
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|
Risk Factors |
Score |
|
|
1. |
Age |
56 or over |
1 |
|
|
|
Age 55 or under |
0 |
|
2. |
Gender |
Male |
1 |
|
|
|
Female |
0 |
|
3. |
Family History |
If you have: |
|
|
|
|
Blood relatives who have had a heart attack or stroke at or before age 60 |
12 |
|
|
|
Blood relatives who have had a heart attack or stroke after age 60 |
6 |
|
|
|
No blood relatives who have had a heart attack or stroke |
0 |
|
4. |
Personal History |
If you have: |
|
|
|
|
50 or under: If you had either a heart attack, a stroke, heart or blood vessel surgery |
20 |
|
|
|
51 or over: If you had any of the above |
10 |
|
|
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None of the above |
0 |
|
5. |
Diabetes |
Diabetes before age 40 and now on insulin |
10 |
|
|
|
Diabetes at or after age 40 and now on insulin or pills |
5 |
|
|
|
Diabetes controlled by diet, or diabetes after age 55 |
3 |
|
|
|
No diabetes |
0 |
|
6. |
Smoking |
Two packs per day |
10 |
|
|
|
Between one and two packs per day or quit smoking less than a year ago |
6 |
|
|
|
If you smoke six or more cigars a day or inhale a pipe regularly |
6 |
|
|
|
Less than one pack per day or quit smoking more than 1 year ago |
3 |
|
|
|
Never smoked |
0 |
|
7. |
Cholesterol (If cholesterol count is not known, answer 8) |
Cholesterol -- 276 or above |
10 |
|
|
|
Cholesterol -- between 225 and 275 |
5 |
|
|
|
Cholesterol -- 224 or below |
0 |
|
8. |
Diet (If you have answered 7, do |
Does your normal eating pattern include: |
|
|
|
|
One serving of red meat daily, more than seven eggs a week, and daily consumption of butter, whole milk, and cheese |
8 |
|
|
|
Red meat 4-6 times a week, 4-7 eggs a week, margarine, low fat dairy products, and some cheese |
4 |
|
|
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Poultry, fish, little or no red meat, three or fewer eggs a week, some margarine, skim milk, and skim milk products |
0 |
|
9. |
High blood pressure |
If either number is: |
|
|
|
|
160 over 100 (160/100) or higher |
10 |
|
|
|
140 over 90 (140/90) but less than 160 over 100 (160/100) |
5 |
|
|
|
If both numbers are less than 140 over 90 (140/90) |
0 |
|
10. |
Weight |
Ideal weight formula:
Men = 110 lb plus 5 lb for each inch over 5 feet
Women = 100 lb plus 5 lb for each inch over 5 feet |
|
|
|
|
25 lb overweight |
4 |
|
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10 to 24 lb overweight |
2 |
|
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Less than 10 lb overweight |
0 |
|
11. |
Exercise |
Do you engage in any aerobic exercise (brisk walking, jogging, bicycling, racquetball, swimming) for more than 15 minutes: |
|
|
|
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Less than once a week |
4 |
|
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1 to 2 times a week |
2 |
|
|
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3 or more times a week |
0 |
|
12. |
Stress |
Are you: |
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|
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Frustrated when waiting in line, often in a hurry to complete work or keep appointments, easily angered, irritable |
4 |
|
|
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Impatient when waiting, occasionally hurried, or occasionally moody |
2 |
|
|
|
Comfortable when waiting, seldom rushed, and easygoing |
0 |
|
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Total Points |
___ |