3. Waist-Hip Ratio: Comparing your waist measurement to your hip measurement tells you whether you've got too much fat in your abdominal area; this fat wrapped around vital organs tends to be more metabolically active than fat on the hips and thighs, spewing out inflammatory chemicals that promote plaque formation. A 2007 study published in the journal Circulation found that men who had the biggest waists in relation to their hips had a 55 percent higher risk of developing heart disease than the men who had the smallest ratios. Women with the highest ratios were 91 percent more likely to develop heart disease than were those with the smallest. The researchers also found that measuring just your waist size was a far less accurate predictor than measuring your waist in comparison with your hips, which suggests that bigger hips might be protective. For women, a waist-hip ratio of 0.80 or below is considered low risk; 0.81 to 0.85 is considered moderate risk; above 0.85 is considered high risk. For men, a waist-hip ratio of 0.95 or below is considered low risk; 0.96 to 1 is considered moderate risk; above 1 is considered high risk. Here's how to measure your waist-hip ratio.
4. Body Mass Index: The comparison of weight and height is generally reliable for assessing body fat, though it can overestimate body fat in athletes who have a lot of muscle and can underestimate body fat in older people who naturally shed muscle mass. Any measurement over 25 means you're overweight and at moderately increased risk of heart disease and 30 or above means you're obese and at greatest risk. Here's how to measure your body mass index.
5. Speed of Menopause Transition: A surprising finding from Cedars-Sinai Heart Institute in Los Angeles shows that women who move through the transition from the first irregular periods of perimenopause to an all-out cessation of menstruation in less than 18 months appear to have a faster accumulation of plaque in their arteries than those who take longer. "Menopause itself doesn't pose a heart risk for women, but those who transition rapidly have more thickness in their carotid artery, an indirect measure of how much plaque is accumulating in the arteries of the heart," says study author C. Noel Bairy Merz. She says the finding could be useful for a woman considering going on hormone replacement therapy to combat hot flashes, mood swings, and other menopausal symptoms. "If she was a former smoker, has a high C-reactive protein level, and went through a rapid transition," Merz explains, "I might be more cautious because previous research has shown that for women who already have clogged arteries, HRT may further increase their heart attack risk."
6. Images of your arteries. Certain cardiac imaging tests can provide even more clues about your individual heart attack risk. The most benign test uses ultrasound (and no radiation) to measure the thickness in the walls of the carotid artery in your neck—something that Merz used in her study. "Newer hand-held devices are very user-friendly and some primary care physicians are starting to do them," Merz says. "It might soon be used like a blood pressure cuff, but we're not there yet."
Another simple heart scan measures calcium in the coronary arteries and uses low-dose radiation, equivalent to the amount in a mammogram. A score of more than 400 means you've got a significantly higher risk of having a heart attack and sudden death and indicates you should probably be taking aspirin and a statin even if you've got no other risk factors, says Blumenthal, who published a study on this. A scan showing no calcium can be useful for ruling out statins if you're already at fairly low risk for heart disease. Most folks, though, have a score somewhere in the middle and the scan may not add too much more information about their heart disease risk.
7. Listen to your body. This is probably one of the most important things you can do to assess your risk. "If you're having heart symptoms—vague chest discomfort, shortness of breath, palpitations, fainting spells, light headedness—don't brush them off just because you've got a low risk profile," warns Myerburg. Seek medical attention as soon as possible. After all, he adds, "a risk profile tells you what may happen in the future, whereas symptoms tell you what's happening now."