Heart Risk Assessment

Name

Address

City

Mobile

Age

Sex

Male   Female

Weight

Height

Blood Pressure

Pulse Rate

Smoking

Yes   No

Hypertention

Yes   No

Diabetes

Yes   No

Sedentery life style

Yes   No

Exercise

3 Days a week   5 Days a week  No Exercise

Alcohol

60 ml/week   Regular  No Alcohol

Hereditary

No   Single  Both Parents

Total Cholesterol

150-180   180-200  200-220  220-250

HDL Cholesterol

20-30   30-40  40-50  50-60

HbA1c

6-7   7-8  8-10

HsCRP

Below 1   1-2  2-3  Above 3

Apo-B

Below 140   140-160

Homocystin

Below 15   Above 15

LDL

Below 100   100-130  130-150  Above 150

Triglyserides

Below 150   150-250  Above 250

Triglyserides

Below 150   150-250  Above 250