1. Personal history of heart ailments, heart attack, bypass, angioplasty:
[0] None,
[2] over 5 years ago,
[4] 2 to 5 years ago,
[5] 1 to 2 years ago,
[6] heart irregularities,
[7] diagnosed hypertension,
[9] has been hospitalized with cardiac episode in the last year,
[10] I have diagnosed heart disease.

2. Smoking:
[0] None,
[2] 1 to 10 cigarettes daily,
[3] 11 to 29 daily,
[5] 30 to 40 daily,
[6] more than 40 daily.

3. Alcohol:
[0] Less than 10 oz. of beer, wine, cocktails pr week,
[2] 10 to 20 oz. per week,
[4] 20 plus oz. per week.

4. Vascular problems:
[0] No known problems,
[4] peripheral area disease,
[6] stroke on transischemic attack.

5. Family history of heart attack:
[0] None,
[2] yes, relative was over 50 years,
[4] yes, relative was under 50 years.

6. Tension and stress:
[0] Mostly relaxed with very little stress,
[1] moderate stress or tension infrequently,
[2] high stress in job or interpersonal relationships,
[3] stress events have made coping difficult,
[4] your personality s one of a very anxious or tense person.

7. Age:
[0] Under 30,
[1] 30 to 39,
[2] 40 to 49,
[3] 50 to 59,
[4] over 60 years old.

8. Diabetes:
[0] None,
[1] family history of Type II or adult onset,
[2] family history of Type I or juvenile diabetes,
[3] you have been diagnosed with diabetes and take oral medication only,
[4] you have been diagnosed and take insulin injection.

9. Weight:
[0] At desired weight,
[2] 10 lbs. overweight,
[3] 20 lbs. overweight,
[5] 30 or more lbs. overweight.

10. Substance abuse
[0] You take no medications for mood altering,
[1] you take prescribed meds for tension,
[2] you use recreational drugs infrequently,
[3] you use recreational or non-prescribed drugs often,
[4] habitual use of non-prescribed drugs.

11. Blood pressure:
[0] 120 or under/85 or under,
[2] usually 140-130/90-95,
[4] usually 160-140/95-100,
[6] usually 180-160/110-100.

12. Sex:
[0] Female
[2] Male

13. Exercise. You perform endurance exercise (walk, run, swim, bike) which provides mild breathlessness:
[0] 3 or more times a week,
[1] one time per week,
[3] none.

14. Nutritional habits:
[0] You try to avoid foods high in fats,
[2] you don't try to avoid fats or cholesterol,
[3] you eat very few fresh vegetables and fruits,
[4] you don't try to avoid foods high in salt/sodium,
[5] you don't eat many complex carbohydrates or starches such as potatoes, rice, pasta, cereals.

Your total score is: