Are You At Risk?


Nurse Dorcas Churchill is checking a patient's heartbeat.

Heart Attack
If you have high cholesterol, figure your risk of a first heart attack.
Fill in your points for each risk factor.

Gender: M     F
Age:
Family History:My family has a history of heart disease or heart attacks before the age of 60. Yes  No
Inactive Lifestyle:I rarely exercise or do anything physically demanding. Yes  No
Weight:I'm more than 20 pounds over my ideal weight (see weight chart below). Yes  No
Smoking:I am a smoker. Yes  No
Diabetes:I am a diabetic. Yes  No
Cholesterol:Total cholesterol level:
HDL Level (Good Cholesterol):
Blood Pressure:My blood pressure is (use your top or higher blood pressure number):
I am currently taking blood pressure medication. Yes     No
   

At-Risk Weight Chart

Height
(feet/inches, without shoes)

Weight
(pounds, without clothing)
 

Women

Men
4'9"
4'10"
4'11"		 134
137
140		 -
-
-
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"		 143
146
150
154
157
161		 -
157
160
162
165
168
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"		 164
168
172
175
178
182		 172
175
179
182
186
190
6'0"
6'1"
6'2"
6'3"		 -
-
-
-		 194
199
203
209

Vijay M. Haryani, M.D., FACC
455 West Court Street, Suite 302, Kankakee, Illinois 60901
(Phone): 815-936-3240 * (FAX): 815-936-3243
(Email): info@haryani.com