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I’d like to introduce you to the heart health pre-check. This is a special health assessment to determine your risk for cardiovascular disease (CVD), the leading cause of death for women and men throughout the United States and the world. To assess your own CVD risk, I encourage you—again!—to contact your health practitioner, always a good idea before embarking on any program of strenuous exercise. Your practitioner will be able to give you the information you need to complete your heart health pre-check. But first, let’s explore a little more about cardiovascular disease.

Cardiovascular disease is a term that encompasses diseases of the heart and blood vessels, coronary artery disease, heart attack, and stroke. A 2017 report by the American Heart Association found that CVD accounted for 801,000 deaths in the United States in the previous year. That means one in every three deaths in the US is due to CVD—a sobering statistic. As a result, identifying risk factors for CVD is vital to avoiding heart problems. A risk factor is anything that makes someone susceptible to a condition or illness; thus, a positive CVD risk factor is something that promotes CVD. A negative CVD risk factor is something that negates a positive CVD risk factor. (Contrary to what its name implies, a negative risk factor offers a health advantage.) This will be easier to understand as we go over the risk factors below.

Below is your heart health pre-check of positive CVD risk factors. Go over this with your health practitioner to better determine if you have any of these risk factors.

1. Family history of heart attack. This would be a heart attack or sudden death before fifty-five years of age in your father (or male first-degree relative, which means your parents, offspring, or siblings) or before sixty-five years of age in your mother (or female first-degree relative).

2. Cigarette smoking. Are you a current smoker or did you just quit within the last 6 months? If yes, this is a positive risk factor.

3. High blood pressure. Is your systolic blood pressure ≥130 mmHg and/or is your diastolic blood pressure ≥80 mmHg? And if so, has this been confirmed on two separate occasions? Or, are you taking an antihypertensive medication? Answering yes to either of these questions means you are at risk.

4. Abnormal cholesterol levels. Is your total cholesterol >200 mg/dL? Is your high-density (good) cholesterol <40 mg/dL? Are you on a lipid-lowering medication? Is your low-density (bad) cholesterol >130 mg/dL? If you can answer yes to at least one of these questions, you have this positive risk factor.

5. Prediabetes. Is your fasting blood glucose ≥100 mg/dL and ≤125 mg/dL, and has this been confirmed on at least two separate occasions? If yes, this would be a positive risk factor.

6. Obesity. Is your body mass index (BMI) ≥30 kg/m2, or waist girth ≥40 inches for men and ≥35 inches for women? Answering yes to any of these means you are at risk.

7. Sedentary lifestyle. Have you been participating in at least 30 minutes of moderate-­intensity (somewhat hard) physical activity at least 3 days a week for the last 3 months? If not, this would be a positive risk factor.

8. Age. Men, if you are forty-five years or older, this is a positive risk factor. Ladies, if you are fifty-five years or older, this is a positive risk factor.

There is only one negative risk factor, which means it negates a positive risk factor: elevated high-density lipoprotein cholesterol (HDL-C). Is your high-density lipoprotein cholesterol (HDL-C) >60 mg/dL? Since this is the good cholesterol, we would like for this value to be above 60 mg/dL. Having high HDL-C indicates this “scavenger” is cleaning up the plaque on your arteries, which is a great health benefit in the prevention of CVD.

Before we move on, let’s quickly discuss how to interpret these CVD risk factors. For example, if a person is sedentary but has no other positive risk factors, we would say she/he has one positive risk factor. If this person also has an HDL-C of 65mg/dL (which is >60mg/dL) this person also has one negative risk factor. Therefore, in this example, the HDL-C negates the sedentary behavior risk. Having HDL-C >60 mg/dL will negate any one of the positive risk factors—but not all of them. Your goal is to have as few of the positive risk factors as possible.

You will not necessarily develop CVD if you have a positive risk factor. Nevertheless, the more positive risk factors you have, the greater the likelihood that you will get CVD at some point in your life. I highly encourage you to adopt a heart-healthy lifestyle in an effort to lower your CVD risk. Here are the key elements of a heart-healthy lifestyle:

1. Minimize all processed foods, as they tend to be loaded with sugar and salt.

2. Eat modest portions of beef, poultry, and pork, and at each meal, try not to eat a serving size of meat that’s bigger than a deck of cards.

3. Limit sugar, particularly sugary drinks, which are the leading source of added sugar in our diets. These added sugars are linked to obesity, diabetes, elevated LDL (bad cholesterol), diminished HDL (good cholesterol), and elevated fat in the blood.

4. Eat more whole grains, nuts, fruits, vegetables, and beans. Try to make them staples of your diet. These foods have those all-powerful heart-protecting antioxidants, plus helpful fiber and healthy fats.

5. Fat consumption is not your adversary. Just try to avoid foods packed with saturated fat such as meat, cheese, and butter. Some fatty foods, like nuts, seeds, olive oil, and salmon, are packed with heart-healthy unsaturated fats. Enjoy these healthier fats in moderation.

6. It’s OK to start eating eggs again. The newest evidence suggests that the intake of eggs does not impact your cholesterol levels as we once thought.

7. If you drink alcohol, limit your intake. Women should have no more than one alcoholic drink per day. Men should have no more than two alcoholic drinks per day.

8. Do 30 minutes or more of moderate-intensity (somewhat hard) physical activity on most days of the week.