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Calculating Your Risk for Heart Disease

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By Charles Defendorf, DO

Heart disease has been defined as the number one cause of mortality in the United States by the Centers for Disease Control and Prevention (CDC). 

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The CDC also notes that heart disease mortality rates are on the decline; likely thanks to improvements in medical care and reductions in risk factors.

Working with your physician to understand and lower your risk for heart attack or stroke is essential for prevention and staying healthy.

Fortunately, there are tools available to help assess your risk level and determine whether you require treatment.

What is the ASCVD Score?

One of the most valuable and common tools doctors use to evaluate your risk for heart attack or stroke is the atherosclerotic cardiovascular disease (ASCVD) risk score. The ASCVD risk score is a numerical representation of your risk of experiencing a cardiovascular event within the next 10 years. 

This score can be calculated if you are between 40 to 79 years of age and should be calculated if there are signs of cardiac risk, such as elevated low-density lipoprotein (LDL).

The score is typically calculated based on a variety of risk factors, including:

  • Age. The older you are, the higher your risk.
  • Gender. Men are about twice as likely to have a fatal cardiac event.
  • Cholesterol levels. Specifically, your levels of high-density lipoprotein (HDL) and total cholesterol.
  • Blood pressure and any medication use for control.
  • Smoking.
  • Diabetes.

Using these factors, a calculator or algorithm determines your ASCVD score. This can help a physician evaluate isolated signs of cardiac risk, such as an elevated LDL, in the context of a more well-rounded clinical picture of a patient’s overall health.

This information can then be a part of a discussion about medical management decisions.

Interpreting your ASCVD Score

  • Low risk (less than 5%). If your ASCVD score is low, your risk of a heart attack or stroke in the next 10 years is minimal and lifestyle choices to maintain or further improve this score is likely all that is needed.
  • Borderline risk (5 to 7.5%). This suggests a moderate risk and preventive lifestyle choice measures remain important. This is also when medications should first be considered.
  • Intermediate risk (7.5 to 20%). This indicates a more significant risk. Your healthcare provider would be more likely to strongly recommend medication in addition to a significant lifestyle change focus.
  • High risk (over 20%). These would be very high scores representing substantial risk of heart disease and come with a definite recommendation for high-intensity statin therapy.

Why is the ASCVD Score Important?

Your ASCVD score is a personalized assessment of your heart disease risk based on your unique profile.

Knowing your score enables you to work with your healthcare provider to take preventive measures such as implementing lifestyle changes or other prescribed interventions to reduce your risk.  Your score can help guide decisions about cholesterol-lowering medications, such as statins.

Individuals with a higher ASCVD score are more likely to benefit from such medications, and the benefit can outweigh the potential risks. 

Moreover, the ASCVD score can be a motivating factor for individuals to make healthier lifestyle choices, such as improving diet, increasing physical activity, and quitting smoking.

Inflammation and Calcium Are Also Markers for Heart Disease

In cases where the ASCVD score indicates borderline or intermediate risk, your physician may recommend additional tests, including tests to detect inflammation and to determine the level of calcium in your heart arteries, both markers for heart disease.

Acute inflammation is a natural function of the body’s immune system to help fight off infection and/or promote healing. 

Inflammation can also be triggered by certain diseases and lifestyle choices, causing chronic inflammation. 

Examples of conditions with chronic inflammation include chronic kidney disease, rheumatoid arthritis, lupus, psoriasis, and human immunodeficiency virus (HIV) infection. 

Chronic inflammation irritates your blood vessels and can promote the growth of plaque in your arteries, including your heart arteries.

Doctors can determine the level of inflammation in your body with C-reactive protein blood testing. Elevated levels, typically greater than or equal to 2.0 mg/L (milligram per liter), would be considered high and indicate inflammation, which could be chronic and potentially contribute to your heart disease risk.

Additionally, coronary artery calcium (CAC) testing, which is performed using a computed tomography (CT) scan, can show calcium deposits in your heart arteries. The greater the number of deposits, the greater your score, and the greater your risk for a heart attack.

Reduce Your Risk

Your ASCVD score as well as tests for inflammation and/or calcium in your arteries can be powerful tools for assessing your risk of heart disease, helping you and your healthcare provider make informed decisions about your heart health. This information can also motivate daily risk reducing lifestyle changes including:

  • Not smoking. Do not start or work with your doctor to quit today.
  • Keeping active. Moderate exercise even for just 20 minutes a day helps reduce inflammation and helps you stay heart healthy.
  • Maintaining a healthy weight.
  • Eating a healthy diet. Processed foods contribute to inflammation and are often high in fat and added sugars. Whole foods, including fruits, vegetables, fish, and legumes, help reduce inflammation and prevent heart disease. Ensure that you consult your doctor about any diet plan to ensure it will not exacerbate other chronic conditions you are controlling.

If you are concerned about your risk for heart disease, talk with your doctor. Understanding and monitoring your cardiac health status empowers you to take charge of your well-being and potentially prevent heart attack and stroke. 

To find a physician affiliated with Penn Medicine Princeton Health call (888) 742-7496 or visit www.princetonhcs.org

Charles Defendorf, DO, is board certified in internal medicine and a member of the medical staff of Penn Medicine Princeton Health.

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