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Calcium Metabolism and Hyperparathyroidism

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  • 1. What is a heart attack risk estimation calculator? This spreadsheet program estimates your risk for having a heart attack over the next 10 years. To do this, it uses answers that you type in for your risk factors for heart attack. The program is intended to help you gain a realistic understanding of your level of risk for heart attack. The progam also estimates what your risk would be if you took cholesterol medicine to lower your LDL cholesterol. The developers of the program (details below) would like to encourage persons whose 10-year risk is above 10% to improve their dietary habits as much as possible and take cholesterol medicine to lower their risk for heart attack. The calculator is based on information about heart attack risk gathered by the Framingham Study since the early 1950s. You may need to get copies of some of your risk factor test results (total, LDL, & HDL cholesterol, triglycerides) from your doctor before you can use the risk calculator. How to calculate & interpret your estimated risk for heart attack for the next 10 years: 1. Click on the UserRiskEstimate sheet (sheet 2) tab below and answer the 23 questions. (Answers for an imagery patient, John Cardiac, are already entered as an example. Just type your answers over those.) 2. Your 10-year risk estimate appears in 2 forms. The estimate in the orange box at bottom of screen ignores your Your risk estimate that includes your family history is shown in the middle of the screen (also in an orange box). 3. The family history adjustment method used in this calculator oversimplifies the modifying effect of family heart attack history on 10-year risk. Because of this, it produces a somewhat overestimated risk for heart attack adjusted for family history The family-history-adjusted estimate probably is a better estimate of your risk for heart attack and stroke combined 4. Your risk estimates (for now and 10 years from now), with & without cholesterol medicine, are shown in the graphs on the right Larger versions of these graphs are shown on the RiskGraphs sheet. Click on this sheet to print out a more legible copy. 5. Your LDL (bad) cholesterol is shown in the perspective of its heart attack risk in the graph in the lower right corner. Scroll down, using the quot;down arrowquot; to see all of it. Click on the LDLPerspective sheet to print out a more legible copy. 6. If you already have coronary artery or heart disease, the calculator cannot give a good estimate of your risk, but it is over 20%. Scroll down twice for more information User Background Information Please answer the following questions if you send a copy of your risk estimate to us*, so we can keep track of what kind of people use the risk calculator. 1. What is your name? (first name, then last name) John Cardiac 2. When were you born? (quot;Mo/Da/Yrquot;; e.g., quot;7/19/46quot;) 11/10/2005 3. How many years of education have you completed? 26 4. What do you consider to be your race or ethnic group? w Enter quot;afquot; for African-American or Black. Enter quot;asquot; for Asian or Oriental Enter quot;hquot; for Hispanic, Spanish, Mexican-American, Chicano, etc. Enter quot;wquot; for Non-Hispanic White, Caucasian, etc. 6/27/2006 5. What is today's date? HeartAge--a different way to think about your risk for heart attack Most people have trouble understanding just what their 10-year heart attack risk really means. A different way to think about your risk is called HeartAge. It is easier to make sense of than 10-yr risk. This method uses your risk factor values to calculate quot;how old your heart isquot;, compared to the heart of the average person your age. It is based on the notion that the hearts of persons with higher risk factor values age faster than the hearts of those with lower risk factor values. If you would like to check this out, go to the internet website www.heartage.com, click on the quot;Try the HeartAge patient toolquot; and follow the instructions to answer the risk factor questions and find out your HeartAge. To make the best use of HeartAge, after you get your HeartAge answer, click quot;Try Againquot; and enter different values for your untreated risk factors that could be improved. For LDL cholesterol, subtract 40% from your value (what taking cholesterol medicine would do). For systolic blood pressure, subtract 20 from your value if it is above 140 or higher & is untreated. For HDL cholesterol, if yours is below 50, add 5 points if you are sedentary but could exercise more. Write down your current HeartAge and your quot;achievablequot; HeartAge and compare them. If you would like to see a graph of your current and achievable HeartAges, enter your values in boxes along the lefthand side of the UserRiskEstimate sheet. You can then view & print the HeartAge sheet. Background of Family-Oriented Risk-of-a-Coronary Estimate (FORCE) calculator This decision support system was first developed in 2002 by Michael Crouch, MD, MSPH, & Kadi Johnson, PT. Dept Family & Community Medicine, Baylor College of Medicine & School of Health Informatics Science, U Texas Houston It was developed in UTHSC courses Health Informatics 5303 & 6309, May-Aug, 2002. It has been extensively revised (2/25/04, 1/31/06, 6/22/06) to make it easier to use and understand. The Framingham risk calculation module is based on the equations in Anderson KM, Wilson PW, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals. Circulation 1991;83:356-62. *Although family history of coronary artery disease is one of the stronger independent risk factors for heart attack, it is omitted from the 1991 & 1998 Framingham risk equations because family history data was not collected for all second generation Framingham Study cohort participants. This heart disease risk estimate calculator combines an individual's estimated risk from Framingham equations with an estimation of risk attributable to their family history. The 1991 version of Framingham equations was chosen because of its including left ventricular hypertrophy (LVH). Although LVH is one of the strongest risk factors, it was left out of later equations because of debate about the precision of the definition of LVH by electrocardiogram (ECG). More recent versions of the Framingham equations (which omit LVH) include: Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silberhatz H, Kannel WB.
  • 2. Prediction of coronary heart disease using risk factor categories. Circulation 1998 May 12;97(18):1837-47. The risk estimator was last revised on June 22, 2006. To Contact the Program Developers Michael Crouch, MD, MSPH Email: crouch@bcm.edu Academic Phone: 713-798-7754 Home Phone: 281-265-2370 Academic Office Address: 3701 Kirby Drive, Suite 600, Houston, TX 77098 Dr. Crouch welcomes constructive criticism and suggestions for improving the risk calculator. Dr. Crouch also welcomes collaboration on validating and/or improving the validity of the family history risk adjustment.
  • 3. cholesterol. bove 10% for heart attack. the early 1950s. cerides) next 10 years: nswers over those.) nores your family history. orange box). amily heart attack history d for family history. stroke combined. n in the graphs on the right. a more legible copy. er right corner. more legible copy. our risk, but it is over 20%.
  • 4. Find out what your risk for heart attack is 10 in 100 20 in 100 Answer these questions to get an estimate of your heart attack risk. Medium risk m 1. Are you male or female? (Enter quot;mquot; for Male, or quot;fquot; for Female) 59 2. What is your current age? (Calculator works only for ages 30 to 74.) 120 3. In the past year, what's been your usual systolic blood pressure? k ris Systolic blood pressure is first & higher of 2 BP numbers. High risk w Lo Your answer normally should be between 90 and 200. Healthy is below 130. Heart If you don’t know, answer “120”. Attack 4. Have you used tobacco in the last year? (n for No, y for Yes) n Risk 5. What has your total cholesterol averaged during the past year? 230 30 or more 0 in 100 Meter Your answer will probably be between 100 & 400. Healthy is below 200. in 100 If you don't know, answer “200.” 40 Interpreting Your Risk: 6. What has your HDL (good) cholesterol averaged in the past year? 0-9% = Low Risk Your answer will probably be between 20 and 100. Healthy is above 50. 10-20% = Medium Risk If you don't know, answer “50.” 7. What has your LDL (bad) cholesterol averaged in the past year? 170 above 20% = High Risk for Heart Attack Your answer will probably be between 70 & 250. Healthy is below 100. 8. What has your triglycerides (TG) level averaged in the past year? 100 John Cardiac Your answer will probably be between 50 & 500, but could be higher. Healthy is below 150, when checked after fasting for 8 hours or more. n 9. Do you have diabetes (high blood sugar)? (n for No, y for Yes) Your chances of a heart attack in next 10 years n (considering your family history) are: 10. Have you had left ventricular hypertrophy diagnosed by ECG? 11. Has your mother experienced heart disease (heart attack or 18in 100 n heart related chest pain? (n for No, y for Yes) n 12. If so, was she younger than 65 when she had this? (n=No, y=Yes) 13. Has your father experienced heart disease? (n for No, y for Yes) n n 14. If so, was he younger than 55 when he had this?(n=No, y=Yes) Your LDL Cho 15. Have any brothers experienced heart disease? (n=No, y=Yes) y 1 16. If so, how many? (Enter number: 0,1,2,3…) 0 17. How many brothers were younger than 55 when they had this? 18. Have any sisters experienced heart disease? (n for No, y for Yes) n 220 19. If so, how many? (Enter number: 0,1,2,3…) 20. How many sisters were younger than 65 when they had this? 69 21. What is your height (how tall are you) in inches? 190 170 22. What is your weight in pounds? LDL Cholesterol n 23. Have you been diagnosed with coronary artery or heart disease? Your chances of a heart attack in next 10 years 14in 100 160 (without considering your family history) 130 100 70 170 1 40
  • 5. Your Risk Now, Compared to Average Risk 20 in 100 risk 20.0 18 18.0 16.0 14.0 12.0 11 10.0 High risk 8.0 6.0 rt 4.0 2.0 ck 0.0 k 30 or more er in 100 My Risk Average Risk our Risk: Your Heart Attack Risk 30 25 Risk for Heart Attack 25 20 18 ardiac 15 13 Chances per 100 10 10 attack in next 10 years ly history) are: 5 25 13 0 2015 18 10 6/27/2006 2005 Untreated Treated Your LDL Cholesterol in Perspective 170 102 170 102
  • 6. Family-Oriented Risk-for-a-Coronary Estimator (FORCE) Copyright 2004 Michael Crouch Risk Estimate Your 10-Year Risk of Heart Attack, Considering Family History of Heart Disease as a Major Risk Factor Estimate 10 A. Your Risk of Having a Heart Attack Over the Next 10 Years (Without Considering Family History)* Years from Current Value Now m 1. Are you male or female? (Enter M for Male, or F for Female) m Ht Gender 69 59 2. What is your current age in years? (This calculator works only for ages 30-74.) 69 Age 3. In the past year, what has your average systolic blood pressure been (1st of 2 BP numbers)? 120 120 Wt SBP (Answer should be between 80 and 220. Healthy is below 130. If you don’t know, answer “120.”) 170 n 4. Do you smoke or have you quit smoking in the last year? (Enter N for No, or Y for Yes) n Smoker 230 5. What has your total cholesterol level been, on average, during the past year? 230 LDL Total (Answer will probably be between 100 & 400. Healthy is below 200. If you don't know, answer “200.” ) Chol 170 LDL on statin 6. What has your HDL (good) cholesterol level been, on average, during the past year? HDL 40 40 TG (Answer will probably be between 20 and 100. Healthy is above 50. If you don't know, answer “50.” 100 HDL on statin 7. Do you have diabetes (high blood sugar)? (Enter N for No, Y for Yes. Leave blank if unsure.) n DM n CHD? n n 8. Have you had left ventricular hypertrophy diagnosed by ECG? (N = No,Y = Yes. Blank if unknown.) n LVH With Current Risk Factors (Framingham Risk) Other Framingham Risk Estimates: 10 Yrs from Now = Your Risk of Having a Heart Attack Over Next 10 Years (Without Considering Family History) 14% 20% Interpreting Your Risk: 0-9% = Low Risk, 10-19% = Medium Risk, 20% or more = High Risk for Heart Attack (Above estimates do not count family history) B. Family History of Heart Attack and Other Forms of Coronary Heart Disease# Statin now, adj for fam 1. Has your mother experienced a heart attack or heart related chest pain (angina)? (N = No, Y = Yes) n hist If so, was she younger than 65 when she experienced this condition? (N = No, Y = Yes) n 10% Heart Age* 2. Has your father experienced a heart attack or heart related chest pain (angina)? (N = No, Y = Yes) n Avg risk same 56.5 n If so, was he younger than 55 when he experienced this condition? (N = No, Y = Yes) age/sex y 3. Have any brothers experienced a heart attack or heart related chest pain (angina)? (N=No, Y=Yes) 11% Achiev- 1 If so, how many? (Enter number: 0,1,2,3…) able 0 How many brothers were younger than 55 when they experienced these conditions? (0,1,2,…) Heart Age Statin treated 10 45.5 4. Have any sisters experienced a heart attack or heart related chest pain (angina)? (N=No, Y=Yes) n yrs adjust If so, how many? (Enter number: 0,1,2,3…) 0 fam hist *from www.heart 13% 0 How many sisters were younger than 65 when they experienced these conditions? (0,1,2,…) age.com Date: 6/27/06 John Cardiac 10 Yrs from now, 1.25 Your Family History of Heart Disease Relative Risk Ratio (1.0 = no increased risk from family history) adjusted for family history Adjusted for family history Caution: This method may overstate risk adjustment for family history and overall risk. 18% = 25% Your 10-Year Risk for Heart Attack, Considering Family History along with Other Risk Factors Interpreting Your Risk: 0-9% = Low Risk, 10-19% = Moderately Increased Risk, 20% or more = High Risk for Heart Attack This decision support system was developed by Michael Crouch, MD, MSPH, & Kadi Johnson, PT, Houston, Texas 6/24/02 Rev 2/25/04 Dept Family & Community Medicine, Baylor College of Medicine & School of Health Informatics Science, U Texas Houston
  • 7. Chol dec Chol 40% by Average decrease statin 10 Risk for 40% by Yrs from this Age statin now Now and Sex m m m 59 69 59 120 120 120 n n n 138 138 200 LDL on statin 102 45 45 45 HDL on statin 45 n n n n n n Statin now Statin 10 Age Avg 8% 10% 11% (Above estimates do not count family history) Risk Now, Adjusted for Family History, Treated with a Statin Risk Now for Same Age/Sex with Averaqe Risk Factors 10 Risk Starting Years From Now, Adjusted for Family History: Treated with a Statin 10 Yrs from now, adjusted for family history Cholesterol Untreated Dept Family & Community Medicine, Baylor College of Medicine & School of Health Informatics Science, U Texas Houston
  • 8. How likely am I to have a heart attack My Heart Attack Risk during the next 10 Years? 30 25 John Cardiac 25 Date: 6/27/06 20 18 13 15 Chances per 100 Risk for a heart attack can be estimated for the next 10 years. 10 10 This is done by entering the risk factors in a computer program. The main risk factors for heart attack are: 5 25 13 · diabetes · age 2015 0 · high blood pressure · sex (males higher risk) 18 10 · cholesterol (high LDL) · smoking or oral tobacco use 2005 · low HDL (good) cholesterol · family history of heart disease Untreated Treated My risk for heart attack in the next 10 years: 18 in 100. (All of these risk estimates include my family history.) My Risk Now, 10 in 100. Taking statin medicine* would cut my risk to: Compared to Average Risk (Estimated risk reduction assumes statin reduces LDL cholesterol by 40%.) 20.0 18 What about my risk more long-term? 18.0 My risk for heart attack 10 years from now: 25 in 100. 16.0 14.0 12.0 13 in 100. Taking a statin would lower that risk to: 11 10.0 8.0 How does my risk compare to 6.0 4.0 other Americans my age? 2.0 0.0 Americans the same age and sex as you, who have 11 in 100. average risk factors, have a 10-year risk of: My Risk Average Risk 10-year risk of heart attack is divided into 3 categories: above 20 in 100 = High risk 10 to 20 in 100 = Medium (above average) risk 2004 Michael Crouch less than 10 in 100 = Low risk
  • 9. What is your HeartAge? Your Heart Total Cholesterol: 230 John Cardiac HDL Cholesterol: 40 LDL Cholesterol: 170 Age: 59 Triglycerides: 100 Date: 6/27/06 Systolic Blood Pressure: 120 Weight: 170 HeartAge TM Body Mass Index (BMI): 25 is a new way to think about your Do you smoke cigarettes? No chance of having a heart attack Do you have diabetes? No or dying of heart disease. Do you have a family history of •  Depending on lifestyle choices, heart attack and/or stroke? Yes family history, and cholesterol Have you had a heart attack levels, your HeartAge will vary. or heart surgery? No •  Your HeartAge may be higher or (If heart attack/surgery, HeartAge less accurate.) 57 lower than your real age. Your Calculated HeartAge: # •  If your HeartAgeis higher than Suggested Goals your real age, your heart attack risk is above average. Total Cholesterol Goal: Ideal below 190 •  If your HeartAgeis lower than HDL Cholesterol Goal: Ideal 60 or more your real age, your heart attack LDL Cholesterol Goal: Ideal below 100 risk is below average. Triglycerides Goal: Ideal below 150 Blood Pressure Goal: Ideal below 120/80 Years You can also check your HeartAge Weight Goal: Ideal: 163 lbs TM by going to the internet website Realistic: 170 lbs www.heartage.com on your computer. (Ideal BMI = 20-24; realistic = 10% less than now if BMI>26) Physical Activity Goal: Walk or exercise Cholesterol is a waxy substance present more vigorously, as close to every day as in many foods. Your liver makes some possible, for 30 minutes or more each time. Diet Goal: Minimize intake of saturated & cholesterol from saturated fat you eat. trans fats. Eat cold water fish (twice a week), • Factors affecting your blood cholesterol nuts (1 oz a day), fiber (10-25 g a day), level include genetics, diet, and exercise. soy protein (40-50 g a day), plant sterols • The right amount of cholesterol helps or stanols (2 servings a day of Benecol, with brain function, sexual function, Take Control, or Smart Balance Omega Plus). and the way you respond to stress. • Too much cholesterol can build up in the Achievable HeartAge: * 46 # walls of blood vessels (arteries) feeding *Based on lowering Total Cholesterol and LDL-C by 40%, your heart or brain. Ruptured blockages can lead to a heart attack or stroke. raising HDL-C by 5 pts, dropping systolic blood pressure by 20 pts (if BP iselevated now), and not smoking HeartAgeTM materials adapted from a Study funded by National Institutes of Health Charles B. Eaton, M.D., M.S., Principal Investigator Center for Primary Care & Prevention Brown Medical School 401-729-2081 Memorial Hospital of Rhode Island # If you have diabetes or heart disease, HeartAge can't be calculated accurately, and your estimates are rougher.
  • 10. *Calculate achievable HeartAge Goal by: Entering Total Cholesterol 33% less Entering HDL Cholesterol 5 pts higher Entering LDL Cholesterol 33% less Entering Triglycerides 33% less Entering BP 20mm Hg less (if high) Enter “no” for smoking Get ideal weight by looking up the weight for their height that would make their BMI=24. Get realistic
  • 11. ur HeartAge Now and Your Achievable HeartAg 60 59 57 n n 50 1.25 46 n 56.5 40 Years 30 Ht Wt 170 69.0 20 45.5 10 0 Chronological HeartAge Achievable Age Now HeartAge
  • 12. I=24. Get realistic weight by averaging their current weight with their ideal weight—e.g., If weight now = 200
  • 13. ht—e.g., If weight now = 200, ideal weight = 140, then their realistic weight = 170.
  • 14. Your LDL Cholesterol Level in Perspective John Cardiac Age: 59 Date: 6/27/06 220 170 190 LDL Cholesterol 160 102 130 100 70 40 170 102 2005 Michael Crouch