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A Nagging Heartache: How to Fight Heart Disease

Risk Assessment

When I return to Dr. Goldberg's office, she gets right down to my lab results. We sit in front of her computer screen. My levels of thyroid-stimulating hormone (TSH) are high, which means my thyroid is underactive. We'll do more testing to determine whether I have mild hypothyroidism, which frequently goes undiagnosed in women and might help explain why I've been feeling sluggish lately. In my case it has nothing to do with my heart. Can I partly blame my weight on a poky thyroid? "It can contribute, but at your levels probably not much," says Dr. Goldberg. So much for excuses.

Next, she shows me the Framingham Heart Study online risk-assessment tool (go to americanheart.org/riskassessment). Those who know their blood pressure and cholesterol numbers can plug them in and do a quick check of how likely they are to have a heart attack within the next 10 years. Experts recommend that everyone find out her risk score by age 20, and reassess every five years after that. Dr. Goldberg plugs in my gender, age, nonsmoker status, and my blood pressure, which at 118/64 is normal. Then she gets to my cholesterol counts, which are all safe, if not optimal: My total is 195; my HDL is 59; my LDL is 118. My non-HDL cholesterol—that's the total minus the HDL—is 136 (normal is less than 160). More good news: I don't have diabetes, despite a history on my maternal grandmother's side. Diabetes raises the risk of heart disease by 20%. In seconds, the tool calculates my 10-year risk. "So here you are: less than 1%," says Dr. Goldberg. Before I get too euphoric, she adds, "But this doesn't mean it's a license to just stay the way you are." While useful, the Framingham tool has notable limitations, points out the doctor. "It doesn't include whether you exercise, or anything about your weight or weight distribution, and it doesn't account for family history."

With a few more clicks, Dr. Goldberg pulls up a newer risk-assessment tool, the Reynolds Risk Score (www.reynoldsriskscore.org), developed by researchers at Brigham and Women's Hospital in Boston. "I risk-score all of my patients on both," says Dr. Goldberg, "but then I also have to integrate other things going on with their health. If patients do these online, they should bring the results to their doctor." Unlike the Framingham online tool, the Reynolds risk assessor asks whether my mother (or father) had a heart attack before age 60. Even with the additional info, my risk in the next decade is still less than 1%.

My job now is to keep it that way. A test of my cholesterol particles reveals they're the light, fluffy kind that are associated with a lower risk of coronary disease, says Dr. Goldberg, though my HDL particles are a little tighter than they could be. To keep them from becoming the dense, artery-clogging kind, I need to do more aerobic exercise. "I wish I could tell my patients that if they dieted and exercised and did everything right, I could give them a 100% guarantee that they're going to be totally risk free," says Dr. Goldberg. "We can't, but it is a big reduction in risk."