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Risk Factors and Risk Assessments

Gabriel Dugue, M.D. & Bradley Boodoosingh
7 min read

Maintaining optimal well-being is a multifaceted endeavor that requires a keen understanding of the various factors that can impact our health.


From traditional bio-indicators to lifestyle choices, being informed about potential risk factors empowers us to make informed decisions for a healthier life. In this article, we delve into some important risk factors that can adversely affect your well-being and provide insights on how to mitigate them.



On the right shows the most common causes of death in America, according to the Centers for Disease Control and Prevention.1





Common Risk Factors


Blood Pressure

Hypertension, or high blood pressure, is often referred to as the "silent killer" and is a significant risk factor that can lead to heart disease and stroke.3 Regular monitoring of blood pressure is crucial, as hypertension typically shows no symptoms until it reaches a critical point.


Investing in an automatic blood pressure pump for your home ensures that you will be able to monitor your pressure regularly. When measuring blood pressure, it is important to keep the arm at heart level to get a more accurate reading. It is also worth noting the differences in blood pressure after eating different foods.



Lifestyle modifications, including reducing sodium intake, maintaining a healthy weight, and engaging in regular physical activity, can help manage blood pressure and lower the risk of cardiovascular issues.




Cholesterol Levels

Elevated cholesterol levels, specifically LDL cholesterol ("bad" cholesterol), contribute to the development of atherosclerosis. In this condition, arteries become narrowed and hardened due to the buildup of plaque which is made from excess cholesterol.

Regular cholesterol screenings, along with a balanced diet low in saturated fats and trans fats, can help keep cholesterol levels in check. Including sources of healthy fats like avocados, nuts, and fatty fish can promote heart health. Many cardiovascular-focused activities have been shown as a natural way to help lower cholesterol such as walking, running, biking, and swimming.


Blood Sugar

Monitoring blood sugar levels is essential for preventing and managing diabetes. Maintaining a healthy diet rich in whole grains, lean proteins, fiber, and regular exercise, can help regulate blood sugar levels.

Paying attention to portion sizes and avoiding excessive consumption of processed or sugary foods and beverages is key to preventing diabetes and its complications.


Waist Circumference

Waist circumference serves as a non-traditional bio-indicator that reflects abdominal obesity.4



Excess fat around the waist is linked to an increased risk of heart disease, diabetes, and other chronic conditions.



Engaging in a combination of aerobic exercises and strength training, along with adopting a balanced diet, can help reduce abdominal fat and improve overall health.



Smoking

Smoking is a lifestyle choice that significantly increases the risk of numerous health issues, including lung cancer, heart disease, and respiratory problems. Quitting smoking is one of the most impactful steps you can take to enhance your well-being.

Seek support from healthcare professionals, join smoking cessation programs, and explore various techniques to quit for good.


Stress Management

Chronic stress can wreak havoc on your overall well-being. Learning effective stress management techniques, such as mindfulness, meditation, deep breathing exercises, and engaging in hobbies, can promote emotional and physical wellness. Prioritizing mental health is an integral part of maintaining a balanced and fulfilling life.




Risk Assessment Tests

Risk assessments are calculators that take into account a variety of factors regarding the patient in question. These can range from age, sex, family medical history, blood pressure, and many more. Risk assessments will typically ask you for specific bits of information and then use that information to synthesize a risk score or risk index. Different types of risk assessments aim to screen you about your risk of different diseases or conditions, and each risk assessment has been created using specific sets of data that may be more accurate for particular sexes or races as compared to others. Understanding the risk assessment you are taking, how it was created, who it is intended for, and for which populations it seems to have the best predictive power will help you to stay better informed on how to best utilize them to improve your health.


Coronary Heart Disease (CHD) Risk Assessment

Coronary Heart Disease occurs when the heart is unable to optimally receive oxygen-rich blood. This usually occurs as a result of plaque building up within the walls of the arteries which restricts blood flow to the heart, thus decreasing the rate and amount of oxygen the heart can receive from the blood. Heart disease is the number one leading cause of death in America. Risk assessment calculators for heart disease and related disorders typically ask for age, sex, race, family history of heart disease, smoker status, total cholesterol, HDL/LDL cholesterol, blood pressure, and medication status.

The following questions aim to predict the risk of heart disease:

  1. Gender - Male or Female

  2. Age - _____ years

  3. Coronary Artery Calcification - _____ Agatston

  4. Race/Ethnicity - Caucasian or Chinese or African American or Hispanic

  5. Diabetes - Yes or No

  6. Currently Smoke - Yes or No

  7. Family history of Heart Attack - Yes or No

  8. Total Cholesterol - _____ mg/dL

  9. HDL Cholesterol - _____ mg/dL

  10. Systolic Blood Pressure - _____ mmHg

  11. Lipid Lowering Medication - Yes or No

  12. Hypertension Medication - Yes or No

This was the Multi-Ethnic Study of Atherosclerosis (MESA) which aims to predict the risk of heart disease for patients between 45-85 years of age within Caucasian, Chinese, African American, and Hispanic populations. Another assessment is The Framingham Risk Score helps to predict the risk for heart disease specifically within a White population and may be more accurate for women.


Diabetes Mellitus (DM) Risk Assessment

Diabetes Mellitus is a condition that occurs when serum blood sugar levels are inappropriately greatly elevated. There are various types of diabetes such as type 1 diabetes when the body’s pancreas does not produce adequate amounts of insulin, type 2 diabetes when the body is insensitive to insulin signaling and thus cannot uptake glucose efficiently leading to higher levels of sugar in the blood, and prediabetes where the body’s blood sugar is elevated but not high enough to be classified as diabetic. Risk assessment calculators for diabetes typically ask for age, sex, race, family history of diabetes, smoker status, frequency of physical activity, BMI, waist circumference, blood pressure, and medication status.

The following questions aim to predict the risk of diabetes:

  1. Age

    1. <40 (0)

    2. 40 - 49 (+1)

    3. 50 - 59 (+2)

    4. >59 (+3)

  2. Gender

    1. Female (0)

    2. Male (+1)

  3. Family history of diabetes

    1. No (0)

    2. Yes (+1)

  4. Hypertension

    1. No (0)

    2. Yes (+1)

  5. Physically active?

    1. No (+1)

    2. Yes (0)

  6. BMI, kg/m2

    1. <25 (0)

    2. 25 to <30 (+1)

    3. 30 to <40 (+2)

    4. ≥40 (+3)

This was the American Diabetes Association (ADA) Risk Calculator that helps to predict the risk of diabetes specifically within American populations greater than 30 years of age. Obtain your score by answering the questions above and then adding together the points from each of your answers as indicated in parentheses. Scores of greater than 5 should be clinically screened for diabetes. Another assessment is the Australian Type 2 Diabetes Risk (AUSDRISK) Assessment Tool helps to predict the risk of diabetes specifically within European, Asian, and Islander populations greater than 25 years of age.


Mental Health Risk Assessment

There are various mental health disorders and complications that can significantly affect daily life. Some common ones include major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD), along with many others. The specific cause of any given mental health disorder can vary greatly between different people, which can hinder attempts to uncover the disorder and its causes. Improved screening techniques, increased awareness, and acceptance of many mental health disorders in recent years have helped to widen the net of patients who are diagnosed and treated. Risk assessment calculators for mental health typically ask for age, sex, family history, medication status, and questions inquiring about feelings and states of mind during various parts of the day.

The following questions aim to predict the risk of depression:

  1. Little interest or pleasure in doing things

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  2. Feeling down, depressed, or hopeless

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  3. Trouble falling or staying asleep, or sleeping too much

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  4. Feeling tired or having little energy

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  5. Poor appetite or overeating

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  7. Trouble concentrating on things, such as reading the newspaper or watching television

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  9. Thoughts that you would be better off dead, or hurting yourself

    1. Not at all

    2. Several days

    3. More than half the days

    4. Nearly every day

  10. If you checked off any problems, how difficult have these problems made it for you at work, at home, or with other people?

    1. Not difficult at all

    2. Somewhat difficult

    3. Very difficult

    4. Extremely difficult


This was the Patient Health Questionnaire (PHQ) 9 produced by Pfizer which helps to predict the risk of depression specifically within American populations greater than 30 years of age. Choices a, b, c, and d respectfully account for 0, +1, +2, and +3 scores when summing results. Scores greater than 9 should be clinically screened for depression or related mental health disorders.



Sources:

  1. Murphy SL, Xu JQ, Kochanek KD. Deaths: final data for 2010. Available at http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf

  2. Centers for Disease Control and Prevention. (2023, January 18). CDC - Leading causes of death. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

  3. Understanding blood pressure readings. www.heart.org. (2023, May 30). https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

  4. Woolley, E. (2022, July 18). What your waist size says about your health risks. Verywell Health. https://www.verywellhealth.com/waist-circumference-and-diabetes-1087703

  5. Bild DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR, Greenland P, Jacob DR Jr, Kronmal R, Liu K, Nelson JC, O'Leary D, Saad MF, Shea S, Szklo M, Tracy RP. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol. 2002 Nov 1;156(9):871-81. doi: 10.1093/aje/kwf113. PMID: 12397006 https://pubmed.ncbi.nlm.nih.gov/12397006/

  6. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

  7. Depression Screening Test. Mental Health America. https://screening.mhanational.org/screening-tools/depression/?ref



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