Risk Stratification
The process by which individuals are assigned to a risk category of low, moderate, or high based on:
The presence or absence of known cardiovascular, pulmonary, and/or metabolic disease.
The presence or absence of signs or symptoms suggestive of cardiovas
Low Risk
Those individuals who do not have signs/symptoms of or have diagnosed cardiovascular, pulmonary, and/or metabolic disease and have no more than one C.V.D. risk factor.
Moderate Risk
Those individuals who do not have signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease, but have two or more C.V.D. risk factors.
High Risk
Those individuals who have one or more signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease.
Cardiovascular Disease (C.V.D.) Diagnosis
Diagnosed with one of the following conditions: Cardiac, peripheral artery (PAD), or cerebrovascular disease.
Pulmonary Disease Diagnosis
Diagnosed with chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, or cystic fibrosis.
Metabolic Disease Diagnosis
Diagnosed with diabetes mellitus (type 1 or type 2), thyroid disorders, and renal or liver disease.
Pain, discomfort, in the chest, neck,
jaw, arms, or other areas that may result from ischemia (an inadequate blood supply to an organ or part of the body, esp. the heart muscles)
One of the cardinal manifestations of cardiac disease, in particular coronary artery disease.
Key features favoring an ischemic origin include: constricting, squeezing, burning, "heaviness" or "heavy feeling". Located in the substernal, across midthorax,
Shortness of breath at rest or with mild exertion
Dyspnea (defined as an abnormally uncomfortable awareness of breathing) is one of the principle symptoms of cardiac and pulmonary disease.
It commonly occurs during strenuous exertion in healthy, untrained persons; however, it should be regarded as abnorm
Dizziness or syncope (a temporary loss of consciousness caused by a fall in blood pressure)
Syncope is most commonly caused by a reduced perfusion of the brain. Dizziness and, in particular, syncope during exercise may result from cardiac disorders that prevent the normal rise (or an actual fall) in cardiac output.
Orthopnea or paroxysmal nocturnal dyspnea
Orthopnea refers to dyspnea occurring at rest in the recumbent position that is relieved promptly by sitting upright or standing.
Paroxysmal nocturnal dyspnea refers to dyspnea, beginning usually 2-5 hours after the onset of sleep, which may be relieved b
Ankle Edema
Bilateral ankle edema that is most evident at night is a characteristic sign of heart failure or bilateral chronic venous insufficiency.
Unilateral edema of a limb often results from venous thrombosis or lymphatic blockage in the limb.
Generalized edema o
Palpitations or tachycardia
Palpitations (defined as an unpleasant awareness of the forceful or rapid beating of the heart) may be induced by various disorders or cardiac rhythm. These include: tachycardia, bradycardia of sudden onset, ectopic beats, compensatory pauses, and accentu
Intermittent Claudication
Refers to the pain that occurs in a muscle with an inadequate blood supply that is stressed by exercise. The pain does not occur with standing or sitting, is reproducible from day to day, is more severe when walking upstairs or up a hill, and is often des
Known Heart Murmur
Although some may be innocent, heart murmurs may indicate valvular or other cardiovascular disease.
Unusual fatigue or shortness of breath with usual activities
Although there may be benign origins for these symptoms, they also may signal the onset of, or change in the status of cardiovascular, pulmonary, or metabolic disease.
mg/dL
Milligram per deciliter
mmol/L
Millimole per liter.
Risk Stratification: Age
Men equal or greater than 45 years old; Women equal or greater than 55 years old.
Risk Stratification: Family History
Myocardial infraction (defined as destruction of heart tissue resulting from obstruction of
the blood supply to the heart muscle), coronary revascularization (defined as the process of restoring blood flow to the heart), or sudden death before 55 years of
Risk Stratification: Cigarette Smoking
Current cigarette smoker or those who quit within the previous 6 months or exposure to environmental tobacco smoke.
Risk Stratification: Sedentary Lifestyle
Not participating in at least 30 min of moderate intensity (40%-60% of VO2R) physical activity on a least three days of the week for at least three months.
Risk Stratification: Obesity
Body mass index equal or greater than 30, or waist girth greater than 102 cm (40 inches) for men and greater than 88 cm (35 inches) for women.
Risk Stratification: Hypertension
Systolic blood pressure (SBP) equal or greater than 140 mm Hg and/or diastolic (DBP) equal or greater than 90 mm Hg, confirmed by measurements on at least two separate occasions.
Risk Stratification: Dyslipidemia
Dyslipidemia is defined as an abnormal amount of lipids (e.g. cholesterol and/or fat) in the blood. Low-density lipoprotein (LDL-C) cholesterol equal or greater than 130, or high-density lipoprotein (HDL-C) cholesterol less than 40.
Risk Stratification: Prediabetes
Impaired fasting glucose (IFG) equal of greater than 100, but less than 126.
Risk Stratification (Negative): High-serum HDL Cholesterol
Equal or greater than 60.
Medical Exam for Low Risk
Asymptomatic (defined as showing no symptoms) men and women with less than one risk factor participating in moderate to vigorous exercise do not necessarily need a medical exam or have medical supervision before, during, or after exercise.
Medical Exam for Moderate Risk
Asymptomatic men and women with one or more risk factors participating in moderate to vigorous exercise should receive a medical exam and possibly medical supervision for all vigorous exercise programs (not necessary for moderate exercise programs).
Medical Exam for High Risk
Men and women with symptomatic, or known cardiac, pulmonary, or metabolic disease should have a medical exam and possibly medical supervision when participating in a moderate or vigorous exercise program.