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The Heart Health Risk Score

I created the Heart Health Risk Score because most of us intuitively understand risk and know how to work with percentages. Addressing someone’s cardiovascular risk can only be done properly if we know their individual risk. Otherwise, it’s easy to resort to population-level, generalized advice such as prescribing blood pressure medication and statins to everyone.

One crucial point to keep in mind is that prevention is the most potent weapon against cardiovascular disease. Despite the advent of new treatments like PCSK9i and better screening tests, nothing is as effective as a robust heart disease prevention strategy.

The objective is to push a heart attack, heart failure, peripheral vascular disease, valvular disease, or a stroke as far into the future as possible.

Heart disease is one of the 4 horsemen of chronic disease according to Dr. Peter Attia.

Heart Health Risk Score Criteria

In a previous article, I discussed the overview of risk stratification. In this article, I want to dive deeper into the anatomy of this score.

I have broken the risk score up into the following categories. It’s a constantly evolving tool that must be revisited often.

1. Age

You might think age isn’t much of a lever, but I disagree. By reading this article and taking action now, you have decided to prevent heart disease earlier than your future self.

In fact, age is the number one risk factor for cardiovascular disease. The older we get, the higher the risk.

2. Family History

A parent who suffered a heart attack at 49 is a powerful risk contributor to the heart risk score. An uncle who suffered heart disease at 79 may not tell us much about this risk.

Your mother’s health and the environment in which she carried the pregnancy portend future risk.

3. Comorbidities

Comorbidities include conditions and diseases that accelerate atherosclerosis or elevate the coagulation response in case of an unstable plaque:

Getting more granular, hypogonadism and severe menopausal symptoms negatively impact the Heart Health Risk Score.

4. Exercise Capacity

While some variables increase the risk of heart disease, others are protective and lower the overall cardiovascular risk score.

A healthy VO2 Max and a higher than average HRV are indicators and may be protective. In fact, exercise improves these metrics and is independently protective against cardiovascular disease.

5. Mental Health

Living in an area with high pollution, loud noise, or constant stress negatively impacts heart health, especially in those who don’t have compensatory coping mechanisms.

Ongoing financial stress, poor sleep, childhood adversities, and relationship stress also elevate the risk score.

6. Imaging Studies

Another category worth considering is imaging studies such as the Coronary Artery Calcium score (CAC) and a CT Angiogram (CTA). We prefer a CTA for general screening and reserve the CAC as a way to screen those on either end of the spectrum.

These are often done preemptively, but they can be quite powerful when they are part of a comprehensive heart risk assessment plan.

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