
| Know who you are! | |||||
| (download PDF) | |||||
| Gender/Age | |||||
| Woman over 50 | yes | no | don't track | ||
| Man over 40 | yes | no | don't track | ||
| Weight | lbs./kgs. | ||||
| Body Mass Ratio (wt-lbs/ht-in²x703) | 18.5 to 25.0 is normal | ||||
| Diet | choose one or two you most often eat | ||||
| Meat and potatoes | |||||
| Chicken and salad | |||||
| Fried vegeterian | |||||
| Deli sandwiches | |||||
| Coffee with cream and pastries | |||||
| Activity level (exercise) | |||||
| No program | |||||
| 5 days per week for 20 minutes | |||||
| 5 days per week for 1 hour | |||||
| Habits | |||||
| Alcohol consumption | glasses per day | ||||
| (2/day men, 1/day women) | |||||
| Cigarette smoking | daily | ||||
| (one per day is a daily smoker) | |||||
| Parents and relatives | |||||
| High cholesterol known | yes | no | don't know | ||
| Low cholesterol known | yes | no | don't know | ||
| Doctor's report | |||||
| My HDL | don't know | ||||
| My LDL | don't know | ||||
| My triglycerides | don't know | ||||
| My total cholesterol | don't know | ||||
| My blood pressure | don't know | ||||
| Medications I take | |||||
| Heart condition | don't know | ||||
| Diabetes | don't know | ||||
| Answering, even thinking about these questions helps you create a personal profile for your own heart health. When it comes to good health, a little knowledge can go a very long way! | |||||