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Screening Results Enclosed Page 1 of 18 Report Date: March 5, 2013 John Q. Test 490 White Pond Dr Akron, OH 44320-1122 Dear Mr. Test, Thank you for your recent participation at the health screening held at Immaculate Heart of Mary Parish Center, sponsored by Sharon Regional Health System. Congratulations on taking an important proactive step in maintaining your future good health! Your Results Your screening results are enclosed. They have been reviewed by a board-certified physician. The following page provides a summary view of all your results. We’ve provided you an additional copy of this page that we encourage you to share with your doctor even if your results are normal. The rest of the report contains more detailed information about each screening test. We suggest you keep your results with your other personal health records. ����������� Next Steps At Life Line Screening, we believe in prevention. We are here to help you lead a fuller and healthier life. With that in mind, here are 3 important steps you can take to maintain your good health: • Share With Your Doctor: Preventive screenings can indicate the presence of a possible problem, but remember that the results of these screenings must be interpreted in the context of your clinical history. Your personal doctor can help with that interpretation. Screening tests can alert you to diseases long before symptoms occur. This is important for early diagnosis and treatment by your doctor. • Stay Up-To-Date: Enroll in our FREE Power of Prevention E-Newsletter by signing up online at www.LifeLineScreening.com/welcome. Every month, you’ll receive important health news , valuable information on new health products and services, and discounts for you or your family & friends. • Schedule Regular Follow-Ups: Screenings should be part of your ongoing health regimen. We will keep track of your past screening history, and notify you when it’s time to be re-screened. For most people, screenings every 12 – 24 months are medically appropriate. Mark your calendar, and plan to make health screening a regular event! Again, congratulations on taking this important step in managing your preventive health routine. At Life Line Screening, we are here to help you every step of the way. Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C. Chief Medical Officer Life Line Screening • Park Center Plaza II Suite 200 • 6150 Oak Tree Blvd. • Independence, OH 44131 www.LifeLineScreening.com • 1-800-897-9177 13-0207_CLV,10000000 - 1111111111 030513 Test, John !20130305:SA130305.017:0001; Page 2 of 18 Screening Results Screening Date: February 07, 2013 Location: Immaculate Heart of Mary Parish Center Fasting: Y D.O.B.: 09/26/1947 Participant Copy John Q. Test Doctor Consultation Recommended: Screening Carotid Artery Disease YES Your Results Compared to Generally Accepted Risk Categories Normal Mild Moderate Significant Normal Mild Moderate Significant Atrial Fibrillation Normal Abdominal Aortic Aneurysm Normal Peripheral Arterial Disease P Normal 0.9 - 1.3 Abnormal < 0.9 Measurement PSV: < 110cm/s Abnormal 4-limb EKG February 2014 Abnormal <3cm Abdominal Aorta Size February 2016 Ankle Brachial Index February 2014 Venous Refill Time (seconds) NOW Unable to Evaluate Left Side: 0.86 Normal 0.9 - 1.3 Abnormal < 0.9 Unable to Evaluate Normal > 21 seconds Abnormal < 17 seconds Inconclusive 18-20 seconds Left Side: Not Taken Low Risk > -1.2 Abnormal < 17 seconds Moderate Risk -1.3 to -2.5 Recommended Next Screening Left: PSV: < 110cm/s Plaque Buildup and February 2014 Blood Flow Right: Right Side: 1.02 Normal > 21 seconds Clinical Measures No Atrial Fibrillation Heart Rate: 75 Beats/min Chronic Venous Insufficiency Osteoporosis NO Inconclusive 18-20 seconds High Risk < -2.6 Right Side: Not Taken -0.5 Bone Mineral February 2015 Density (BMD) Carotid Artery Illustrations for each Results Category You Are Here Normal No plaque present. Blood flow normal. (Blood velocity <110 cm/s) Mild Small amount of plaque, blood flow still normal. (Blood velocity <110 cm/s) Moderate Moderate amount of plaque, blood flow reduced. (Blood velocity 110-139 cm/s) Significant Large amount of plaque, Blood flow is significantly reduced. (Blood velocity >140 cm/s) When detected early and with appropriate modification of stroke risk factors, 80% of strokes can be prevented. Normal Key Mild Moderate Borderline Findings of Possible Significance Page 3 of 18 Screening Complete Lipid Panel Your Results Compared to Generally Accepted Risk Categories Measurement Desirable <200 mg/dL Borderline 200-239 High Risk >240 137 Protected Against Heart Disease >60 mg/dL Desirable 40-59 Risk for Heart Disease <40 mg/dL 60 Near/Above Optimal 100-129 Optimal <100 mg/dL Borderline 130-159 Borderline High 150-199 Normal <150 mg/dL High 160-189 High 200-499 Very High >190 mg/dL Very High >500 mg/dL 62 76 Clinical Recommended Next Screening Measures Total Cholesterol mg/dL HDL Cholesterol mg/dL February 2014 LDL Cholesterol mg/dL Triglycerides mg/dL Glucose Normal <100 mg/dL Pre-diabetes 100-125 Diabetes >126 mg/dL 146 GLU mg/dL February 2014 C-Reactive Protein Low Risk <1 mg/L Moderate Risk 1-3 mg/L High Risk >3 mg/L 0.40 CRP mg/L February 2014 Low Normal Abnormal High Abnormal High Critical 0.83 Kidney Disease Heart Risk Assessment Body Mass Index Blood Pressure ����������� Waist Normal Possible Chronic Kidney Disease Possible Critical Kidney Failure 60 Low Risk <1% Moderate Risk 1-29% High Risk >30% 12 Underweight <18.5 Normal Normal 18.5-24.9 Prehypertension Moderate Risk 25-29.9 High Stage 1 Normal M <40 / F <35 High Risk >30 High Stage 2 High M >40 / F >35 21 creatinine mg/dL February 2014 eGFR mL/min/1.73 m2 10-yr Heart February 2014 Risk % lbs/in2 Height: 6'02" February 2014 Weight: 165 lbs 198/78 mmHg February 2014 38 Inches February 2014 Certain blood tests were processed at Home Healthcare Laboratory of America (a LabCorp Company) 320 Premier Court, Suite 220, Franklin, Tennessee 37067 Normal Key Mild Moderate Borderline Findings of Possible Significance Page 4 of 18 6 for Life Health Assessment A healthier future starts NOW! Congratulations on taking our new 6 for Life Health Assessment. This comprehensive screening measures key risk factors like cholesterol levels and blood pressure, but takes them one step further to determine your future risk for 6 major, chronic conditions that are largely preventable. Unlike a traditional health risk appraisal that simply determines your risk factor category, 6 for Life is a disease risk assessment that demonstrates how your risk factors impact your chance of developing specific disease conditions. Your risk scores were calculated using a proprietary Life Line Screening scientific algorithm that is based on the most current scientific studies, as well as the landmark Framingham Heart Study. Your medical history plus clinical screening results for cholesterol, glucose (blood sugar), blood pressure, Body Mass Index and waist measurement were used to calculate these scores. 6 for Life provides disease risk scores as well as which risk factors are contributing to your risk, so you can continue to improve your health status. We encourage you to add the 6 for Life Health Assessment to your preventive health routine. 6 for Life Disease Condition Your Results Category Risk Score #1. Coronary Heart Disease (CHD) 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 33 #2. Congestive Heart Failure (CHF) 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 25 #3. Stroke 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 29 #4. Diabetes 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 53 #5. Chronic Obstructive Pulmonary Disease (COPD) 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 75 #6. Lung Cancer 0-20 Low 21-40 Moderate 41-70 High 71-100 Very High 80 13-0207_CLV,10000000 - 1111111111 030513 Test, John Your Results Page 5 of 18 Condition Details What Does it Mean to Me? Carotid Artery Disease One of the leading causes of stroke is fatty plaque buildup in the carotid arteries, which may block adequate blood flow to the brain. The carotid arteries are the main blood supply to the brain and are located on each side of the neck. Our screening is not meant to be a comprehensive diagnostic exam, but rather a screening to visualize the presence of plaque which may affect the blood flow to the brain. Your Carotid Artery Disease Screening results are reported as one of four (4) categories which describe the amount of plaque buildup identified: Within Normal Range, Mild to Moderate, Moderate, and Findings of Possible Significance. Mild: Fairly low to moderate amount of plaque buildup not affecting blood flow velocities. Your Carotid Artery Disease Screening results are Mild. This means that we have identified a fairly low to moderate amount of plaque buildup in one or both of your carotid arteries, which is insignificant. The blood flow in your carotid arteries is within normal range. Since the plaque buildup is not affecting the rate of blood flow, the velocity measurements for the internal carotid arteries will not be stated specifically in this report. However, your velocities fell below 110 centimeters per second, which is within normal range. You are here. Your screening revealed minor plaque buildup which does not affect blood flow. Atrial Fibrillation Atrial Fibrillation or AF is the most common type of irregular heart rhythm or arrhythmia. During AF, the upper chambers of the heart beat rapidly and irregularly so that blood is not completely pumped out of the heart. This can cause blood to collect in the heart and form a blood clot. If the clot travels to the brain, it can cause a stroke. Our screening is a 4-limb EKG and is not meant to be a comprehensive 12-lead EKG (electrocardiogram). It is a screening to identify only the presence or absence of an atrial fibrillation heart rhythm at the time of the screening. Normal: Your Atrial Fibrillation Screening results are Normal. No Atrial Fibrillation detected. This means that at the time of your screening, your heart rhythm did not show evidence of atrial fibrillation. Abdominal Aortic Aneurysm ����������� The aorta is the largest artery in the body, traveling from your breastbone to the level of your navel. Medical conditions, such as high blood pressure and fatty plaque buildup, can weaken the walls of the aorta, causing an enlargement or aneurysm. An aneurysm can form in any section of the aorta, but they are most common in the belly area (abdominal aorta). Normal: No abdominal aortic aneurysm has been detected. Our physician has reviewed the ultrasound images and measurements of the aorta and bifurcation of the iliac arteries. All measurements are within normal limits. Our screening uses an ultrasound examination of the abdominal aorta to screen for the presence of either type of aneurysm that is 3 cm or greater. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 6 of 18 Peripheral Arterial Disease Peripheral arterial disease or PAD is a condition in which fatty plaque builds up in the arteries leading to the arms and legs. One way to screen for PAD is by measuring the Ankle-brachial index (ABI). A small ultrasound device is used to measure your systolic pressures in both of the arms and legs. A ratio less than 0.90 indicates plaque buildup and possible peripheral arterial disease. A ratio of 0.90 to 1.3 is considered normal. Abnormal: Your Peripheral Arterial Disease Screening results are Abnormal. ABI index less than 0.90. This means that you may have a borderline or higher level of plaque buildup in the arteries in your legs. These findings are considered to be abnormal, and we recommend further evaluation with your primary care physician. People with PAD may also have fatty buildup in the arteries of the heart and because of this association, may be at a 4 to 6 times increased risk for heart disease. Please see your physician to determine if additional follow up testing may be necessary. Please take this report to your physician. Your physician may or may not determine that further testing is necessary at this time. Osteoporosis Risk Assessment Osteoporosis is a condition in which the bones are severely weakened and brittle. As a result, fractures occur easily. Life Line Screening performs an osteoporosis risk assessment using quantitative ultrasound to measure the density of the heel bone. The heel is measured because its bone is similar to that found in the spine or hip, where osteoporotic fractures occur most. Your T-score is -0.5 , which is Low Risk for Bone Diminishment. You may wish to speak to your physician regarding risk factor management and proactive steps such as weight-bearing exercise and calcium and vitamin D supplementation. This screening is a risk assessment for bone loss and is not meant to diagnose osteoporosis. Further evaluation and diagnostics may be considered. Talk to your physician about your risk factors for bone loss. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Your Results Page 7 of 18 Condition Details What Does it Mean to Me? Total Cholesterol Cholesterol comes from the foods we eat (anything from animals) and from our body (liver). Excessive cholesterol is a risk factor for heart disease, stroke and type 2 diabetes. Normal: Your Total Cholesterol is 137mg/dL (<200). It is within the Normal Range and meets the National Cholesterol Education Program (NCEP) recommendation of total cholesterol below 200 mg/dL. HDL (High-Density Lipoprotein) HDL carries excess cholesterol away from your arteries. The higher your HDL, the better. An HDL of 60 mg/dL or higher is beneficial and considered protective against heart disease. High: Your HDL Cholesterol is 60 mg/dL (> 60). It is High and meets the NCEP recommended level of 40 mg/dL or more. LDL (Low-Density Lipoprotein) LDL is the main source of cholesterol that contributes to the buildup of fatty plaque in your arteries. Normal: Your LDL Cholesterol is 62 mg/dL (<100)It meets the NCEP recommendation of LDL cholesterol below 100 mg/dL. Triglyceride Triglycerides are another contributing cause of plaque buildup, which can cause artery blockage and heart disease. Triglycerides circulate in your blood, but when you have excess levels, they are stored in the body’s fat cells. Normal: Your Triglyceride level is 76 mg/dL (<150). It is Normal and meets the NCEP recommendation of triglycerides below 150 mg/dL. Glucose Glucose is only one indicator for diabetes risk. Obesity, family history, ethnicity, age, blood pressure and cholesterol are also risk factors that should be considered in assessing your overall diabetes risk. Abnormal: Your Glucose level is 146 mg/dL (>125). It is Abnormal according to the American Diabetes Association guidelines and could indicate Diabetes if confirmed by your physician. Diabetes is a serious condition that puts you at risk for stroke, heart disease and other conditions. However, there are many ways to manage diabetes and prevent other complications. We recommend you see your primary care physician to fully evaluate your risk for diabetes. ����������� C-Reactive Protein CRP is part of your immune system and becomes elevated in your blood as a result of infection or inflammation. Although CRP is an independent risk factor for cardiovascular disease, it is a non-specific and should not be used to identify risk alone. Other risk factors including age, family history, blood pressure, smoking status, weight, exercise level and stress level are also considered when assessing cardiovascular disease risk. Low Risk: Your C-reactive Protein (CRP) level is 0.40 mg/dL (<1.0). This means you are at Low Risk for developing cardiovascular disease. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 8 of 18 Chronic Kidney Screening Early kidney disease doesn't have symptoms, so testing is the only way to know how your kidneys are working. Creatinine is a protein produced by muscle, released into the blood and then eliminated by the kidneys. With normal kidney function, the blood creatinine level is usually constant from day to day. When kidney function decreases below 60% capacity, the creatinine level in the blood increases to an elevated level because the kidneys cannot adequately filter out the creatinine. Normal whole blood creatinine levels are 0.50 to 1.50 mg/dL in men and 0.4 to 1.1 mg/dL in women. Women generally have lower creatinine levels because of less muscle mass. In the early stages of kidney failure, the changes in creatinine can be very small. Therefore, physicians use a measurement called the eGFR (Estimated Glomerular Filtration Rate) to better evaluate how well the kidneys are working. Specifically, eGFR estimates how much blood passes through the tiny filters in the kidneys (called glomeruli) each minute. Normal GFR varies according to age, gender, and body size, and declines with age. In healthy adults, the GFR is between 100 and 130 mL/min/1.73m2. Your eGFR was calculated using the National Kidney Foundation's MDRD equation. The eGFR takes into account the creatinine level plus age, gender and race and is used to screen for and detect chronic kidney disease. The eGFR may be underestimated when a person has less muscle in their body composition, including elderly individuals, people who are extremely obese, malnourished, pregnant women or those who follow a strict vegetarian diet. Your whole blood creatinine level is 0.83 mg/dL (Men: 0.50-1.50; Women: 0.40-1.10). This is within the Normal Range and does not indicate possible kidney damage. Your eGFR was 60 or higher mL/min/1.73 m2, which means your kidneys are still functioning at an adequate level. The normal GFR for a healthy adult is between 100-130 mL/min/1.73 m2. An eGFR that is 60 or greater means the kidneys are still functioning between 60-100% capacity, and there is no significant kidney damage. Your kidneys may be normal; however, if you have symptoms or have additional evidence of kidney damage from other tests (abnormal pathologic, blood, urine or radiology tests), it is possible you have some kidney damage that has yet to impact your kidney function to a significant level. Only your physician can order a complete diagnostic evaluation of your kidney function. Heart Risk Assessment The Heart Risk Assessment Score is based on the Framingham Heart Study's 10-year risk of first time hard coronary heart disease, which includes heart attack (blood flow blocked to the heart muscle) or dying from heart disease in the next 10 years. The Framingham Heart Study is a world-renown landmark study that has generated over 2,000 published articles on the prevention of cardiovascular disease. The algorithm scoring is part of the National Cholesterol Education Program guidelines, issued by the National Institutes of Health. The score applies to adults aged 20 through 79 years who do not have existing heart disease (e.g. previous heart attack), diabetes, carotid artery disease, peripheral arterial disease or an abdominal aortic aneurysm. If you have any of these conditions, your Heart Risk Assessment score is greater than 20%, since these conditions contribute significant risk to heart disease. The risk factors used to determine this score include: age, gender, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for high blood pressure and smoking status. Your Heart Risk Assessment Score, reported as “10-Year CHD Risk”, is 12 %. That means about 12 of 100 people with this level of risk will have a heart attack or die of heart disease within the next 10 years. There are many things you can do to reduce your risk, such as diet and exercise in addition to medications that can help you proactively reduce your risk. We recommend you speak with your physician about what you can do to reduce your heart disease risk. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 9 of 18 Body Mass Index Body Mass Index (BMI) is a number calculated from a person's weight and height, that correlates with total body fat amount. BMI screening is used to assess excess weight. If your weight and height were measured at the screening event, these values were used to calculate your BMI. Otherwise, your self-reported weight and height were used. Based on the calculated BMI, the National Heart, Lung, and Blood Institute categorizes a person's BMI as Underweight, Normal, Overweight or Obese. The term "Overweight" means having extra body weight from muscle, bone, fat, and/or water. The term "Obese" means having a high amount of extra body fat. Being overweight or obese puts you at higher risk of developing serious health problems, including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers. It is important to achieve a healthy weight to reduce your risk of these conditions. Treatment for overweight and obesity includes lifestyle changes, such as reducing calories, following a healthy eating plan and being physically active. Normal: Your Body Mass Index 21 lbs/in2 (18.5-24.9). This is considered Normal according to the National Heart, Lung, and Blood Institute guidelines. Congratulations on achieving a healthy weight, which has many benefits including lowering your risk of heart disease, stroke, colon cancer and more. To maintain your weight, adopt a healthy eating plan and aim for 60 minutes of physical activity most days of the week. BMI is calculated as: Weight in Pounds *703/Height in Inches2 Blood Pressure Your Blood Pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood Pressure is given as two numbers. The top number is the Systolic Blood Pressure, which is the pressure when the heart beats while pumping blood. The bottom number is the Diastolic Blood Pressure, which is the pressure when the heart is at rest between beats. Blood pressure is measured in mmHg (millimeters of mercury). Critical High: Your Blood Pressure is 198/78 mmHg (Systolic 190 and above or Diastolic 100 and above). This is considered High Blood Pressure according to the National High Blood Pressure Education Program guidelines and a Critically High Level. Severely high blood pressure is a medical emergency that requires immediate attention. It can cause bleeding in your brain, heart attack, heart failure, kidney failure and loss of vision. A common cause of severely high blood pressure is not taking your blood pressure medicines properly. It's important you work with your personal physician to control your high blood pressure and prevent recurrences of critically high levels. ����������� Waist Measurement Waist measurement is a useful screening for health risks associated with excess weight. Excess abdominal fat increases the risk of heart disease and type 2 diabetes. This risk increases with waist measurements greater than 35 inches for women or greater than 40 inches for men. Normal: Your Waist Measurement is 38 inches (Men: 40 and below or Women: 35 and below). This is considered Normal according to the National Heart Lung and Blood Institute. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 10 of 18 6 For Life Health Assessment Coronary Heart Disease (CHD) Coronary Heart Disease is the leading cause of death in the United States, and occurs when arteries that pump blood to the heart become narrow or clogged by fatty cholesterol deposits. When these vessels are not able to provide enough oxygen-rich blood to the heart muscle, chest pain (Angina) develops. If the heart is without enough oxygen for too long, death of heart tissue occurs – also known as a heart attack. There are risk factors for CHD that a person cannot control, such as being male – over age 40, post-menopausal females, having a family history of CHD, and diabetes. Your Coronary Heart Disease (CHD) score of 33 indicates your risk for this condition is Moderate. Because you are a male who is 40+ years old, your risk is increased. You should focus on managing risk factors you can control to help prevent the onset of CHD. Congestive Heart Failure (CHF) Congestive Heart Failure usually takes many years to develop, and is often the result of heart disease, a heart attack, or a heart valve defect. With CHF one or both of the chambers of the heart (ventricles) responsible for pumping oxygen-rich blood to the body become weak. The heart muscle is not strong enough to sufficiently pump blood to all parts of the body. When CHF occurs in the left ventricle, blood and fluid collect in the lungs or heart. When CHF occurs in the right ventricle, fluid congests the legs and feet. Congestive Heart Failure is the number one cause of death in people age 65 and older. With CHF, the cause of death is either acute pulmonary edema (fluid in the lungs), or an arrhythmia (irregular heart beat). Your Congestive Heart Failure (CHF) score of 25 indicates your risk for this condition is Moderate. Fortunately you do not have a personal history of CHF, or conditions that increase your risk for CHF, such as diabetes, coronary heart disease, atrial fibrillation, or valvular/congenital heart disease. Positively managing lifestyle behaviors related to CHF, diabetes, and coronary heart disease you can effectively keep your risk down for developing CHF later in life. Maintaining a healthy blood pressure, blood sugar, cholesterol, and weight through diet and exercise, drinking alcohol only in moderation (if at all), and avoiding tobacco use are recommended. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 11 of 18 Stroke Like a heart attack, a stroke is the result of inadequate blood flow, but the affected organ is the brain rather than the heart. A stroke occurs when arteries bringing oxygen-rich blood from the heart to the brain become blocked or burst. Without the oxygen-rich blood, the affected brain tissue begins to die. The physical effects of a stroke depend on the area of the brain that is affected. A stroke can lead to permanent impairment of mental function, vision, coordination, speech, and even paralysis and death. A Transient Ischemic Attack (TIA) is similar to a stroke, but the blood flow to the brain is only temporarily blocked or slowed. A TIA may have the same symptoms of a stroke, but the effects only last from a few minutes to 24-hours and then disappear. Although the effects of a TIA are not permanent, a TIA is a serious warning sign of stroke risk. Your Stroke score of 29 indicates your risk for this condition is Moderate. Because your age is 55+ your risk for stroke or TIA is slightly increased. However, you do not have a family history of stroke or TIA. You also do not have a personal history of conditions that increase your risk for stroke, such as diabetes, cardiovascular disease, or atrial fibrillation. Modifiable risk factors for stroke or TIA include high blood pressure, high cholesterol, and obesity. Eating a proper diet and getting regular physical activity can help avoid or manage these risk factors. Not smoking, avoiding exposure to 2nd-hand smoke, and drinking alcohol only in moderation are also important lifestyle choices to control your risk of stroke or TIA. Diabetes There are three primary types of diabetes; Type-1, Type-2, and Gestational. Type-1 diabetes is an autoimmune disorder where the immune system attacks and destroys cells in the pancreas responsible for producing insulin which is an important hormone needed for the body to absorb blood sugar or glucose. ����������� Type-2 diabetes is a disease where the pancreas produces insulin, but the body is unable to use it appropriately to absorb blood sugar for energy. This type of diabetes is often associated with lifestyle and modifiable risk factors such as poor diet, physical inactivity, and being overweight. Gestational diabetes is a condition that occurs in pregnant women sometimes, and is characterized by a lack of insulin production. This form of diabetes usually goes away shortly after child birth, but can lead to the development of Type-2 diabetes later in life. Your Diabetes score of 53 indicates your risk for this condition is High. While you cannot control non-modifiable risk factors such as age, race, family history of diabetes, or a personal history of gestational diabetes, you have control of modifiable risk factors related to being physically active, eating a healthy diet, maintaining a healthy weight, and not smoking. It is also important to maintain healthy levels of cholesterol, triglycerides, blood sugar (glucose), and blood pressure. Before people develop type 2 diabetes, they often have “prediabetes”, when blood glucose levels are elevated, but not yet high enough to be diagnosed as diabetes. Research shows that damage to the heart and circulatory system may already be occurring during prediabetes. The good news is people with prediabetes can prevent type 2 diabetes by lifestyle modifications including eating healthy, being physically active, and maintaining a healthy weight. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 12 of 18 Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is a breathing condition that worsens over time, making it hard to breath and interferes with the ability to do activities. Those with chronic bronchitis or emphysema are said to have COPD. Symptoms of COPD include regular coughing that produces phlegm or mucus, shortness of breath, and chest tightness. COPD is the 3rd leading cause of death in the United States, and cigarette smoking is the leading risk factor for developing COPD. Your COPD score of 75 indicates your risk for this condition is Very High. While you have no control over your age, having asthma or a family history of COPD, you can avoid smoking cigarettes and 2nd-hand smoke exposure. There is no cure for COPD, so avoiding these modifiable risks is important to help control your risk for developing this lifelong condition. Lung Cancer Lung cancer is a life-threatening condition that occurs when cancer cells form in the lungs, usually in the cells lining the air passages. There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is more common, faster growing, and often spreads to other organs. Treatment methods are specific to the type of lung cancer present because each grows and spreads differently. Your lung cancer score of 80 indicates you are at Very High risk for this condition. It is good you do not have a family or a personal history of lung cancer. One of the greatest risks of developing COPD and lung cancer is from smoking cigarettes. It is important that you consider options to help you stop smoking to prevent complications with COPD and increased risk for lung cancer. Avoiding 2nd-hand smoke is also an important lifestyle choice to control your lung cancer risk, and complications with COPD. While cigarette smoking is the leading cause of lung cancer, other risks include exposure to 2nd-hand smoke, air pollution, asbestos, radon gas, radiation therapy of the lungs, and several other chemicals. However, lung cancer can also develop if it runs in your immediate family. Because lung cancer is the deadliest form of cancer for both men and women, it is important to avoid the risk associated with the condition. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 13 of 18 6 For Life Health Assessment: Lifestyle Choices Physical Activity You reported 0 (zero) days a week that included 60 minutes of exercise. Currently your weekly amount of physical activity does not meet recommended guidelines. The American College of Sports Medicine (ACSM) and the American Heart Association (AHA) suggest you get 30 minutes of moderately intense exercise five days a week, or 25 minutes of vigorously intense cardiovascular exercise three days a week. Activities can be split into several short periods (e.g., 10 minutes 2-3 times a day). Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary. The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease. Physical activity helps control weight, cholesterol levels, and diabetes. Regular physical activity also helps prevent heart disease, slows bone loss associated with aging, lowers the risk of certain cancers, helps reduce anxiety and depression, can increase your energy level, and can help you sleep better. By choosing activities that interest you and alternating your routine, you can avoid boredom and add enjoyment to your physical activity. Note: These recommendations are for individuals who have not been told by a health professional to avoid physical activity. If you suffer from a health condition that limits your ability to be physically active, or that could possibly be harmful to your health if you increase your physical activity, you should consult a physician prior to making any changes in your activity level. Nutrition ����������� You reported consuming high-fat or fried foods once in a typical day. National dietary guidelines recommend maintaining a total fat intake of no more than 20%-35% of your total daily calories. Of your daily fat calorie intake, less than 10% should come from saturated fat, and you should consume as little trans fats as possible. Fats and oils are necessary parts of a healthy diet, and play essential roles in the body. Fat provides energy, and is a carrier of important nutrients such as vitamins A, D, E, and K, and carotenoids. However, not all fats have a positive effect on the body. Saturated fat and trans-fat should be avoided, since they may increase the risk of heart disease and other health conditions. Most fats in your diet should come from foods containing polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When selecting meat, poultry, and milk products, you should choose those that are lean, low-fat, or fat-free. Continue to eat a diet low in fat. Your positive eating habits will help you to control your weight, increase your energy level, and reduce your health risks. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 14 of 18 Alcohol You reported having 0 alcoholic drinks in a typical week. Alcohol has high calorie content. By not drinking alcohol, you avoid those extra calories. You are also avoiding risk for many health problems related to excessive alcohol use, such as cirrhosis of the liver, and cancer. Drinking alcohol in moderation, especially red wine, has been shown to reduce the risk of heart disease. However, excessive alcohol consumption increases your risk for cardiovascular disease, stroke, and congestive heart failure. The recommended limit for alcohol is no more than 14 drinks per week for men. Smoking and 2nd-hand Exposure You currently smoke 1-10 cigarettes per day, and you have smoked for 1-10 years. Smoking cigarettes can be costly, both in financially supporting the habit, and in terms of your personal health. Smoking is associated with many health risks, including cancers of the mouth, throat, and lungs, heart disease, high blood pressure, stroke, asthma, Chronic Obstructive Pulmonary Disease (COPD), dental issues, weakened immune system, and advanced wrinkling and aging of the skin. You may also experience difficulty sleeping, and a reduced energy level. Consider talking with your physician or a tobacco specialist to find a plan to help you stop smoking. It may take several attempts. Perhaps you are currently trying to quit, or have tried unsuccessfully to quit already. The improved health benefits can begin to show almost immediately, and research shows that after 10 years of quitting, the effects from smoking can almost be completely diminished. Exposure to second-hand smoke places you at an increased risk for the same negative health effects a tobacco user may experience, such as cardiovascular disease and cancer. Try to minimize your exposure to reduce your risk. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 15 of 18 Take Action TALK TO YOUR DOCTOR Screening results are solely for informational purposes and are not medical advice. Please remember that the results of these screenings must be interpreted in the context of your clinical history. We recommend sharing your results with your personal physician, so they can fully evaluate your screening results and recommend a treatment plan for you, if necessary. IMPORTANT: It is possible to have a normal screen with Life Line Screening and still suffer a stroke or a heart attack. Life Line Screening screens for the leading causes of stroke, however, we do not screen for every possible cause of stroke and no screening can screen for every possible variation of vascular disease. Please note, we do not screen your heart for heart attack risk. Specifically, we do not screen the coronary arteries, the arteries surrounding the heart. If you are experiencing symptoms of a heart attack or stroke, SEEK MEDICAL ATTENTION IMMEDIATELY. Do not delay, regardless of your Life Line Screening results. KEEP INFORMED Don’t forget to sign-up for our free monthly electronic newsletter to receive ongoing health benefits at www.LifeLineScreening.com/welcome. COPIES OF ULTRASOUND IMAGES AND EKGS We keep a copy of ultrasound images and EKGs on file for 4 years. For a minimal service fee, you may obtain additional copies of your carotid artery, aorta ultrasound images and EKG printout. Please call 1-800-897-9177 and select option 3 to order through our Customer Service department. YOUR RISK FACTORS Based on your screening results and answers to the health questions, below are your risk factors which elevate your risk for cardiovascular disease and other chronic conditions. Certain risk factors can be controlled (modifiable), while others cannot (non-modifiable). *Source: This section retrieves information from test results and from your self-reported medical history. Modifiable Risk Factors* •Current smoker •Lack of Exercise •Exposure to 2nd hand smoke Non-Modifiable Risk Factors* •Age ����������� Screenings in California are provided by Life Line Mobile Screening in a physician owned practice. Screenings in Kansas are performed by Life Line Screening of America, Ltd. on behalf of Life Line Screening Physicians, P.A. Screenings in New Hampshire, New Jersey and New York are performed by Life Line Medical Screening, LLC (Dr. Andrew Manganaro, 70 Niagara Street, Buffalo NY, 14202). Life Line Screening does not engage in the practice of medicine in those states. This information is not intended to induce referrals by Life Line Screening to Life Line Medical Screening, LLC for any professional medical service. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 16 of 18 This Page Intentionally Left Blank Page 17 of 18 PLEASE GIVE THIS PAGE TO YOUR PHYSICIAN Dear Physician of Life Line Screening Customer: On the other side of this page are the screening results for one of your patients. These results were found in a recent screening performed by Life Line Screening for stroke, heart disease, aortic aneurysm, peripheral arterial disease and osteoporosis. As a fellow physician, a vascular surgeon for over thirty years, and currently the Chief Medical Officer of Life Line Screening, I’d like to share some thoughts with you: Life Line Screening is the largest provider of community-based preventive health screenings in the world. We currently provide screenings throughout the continental United States, the United Kingdom, Ireland and Australia. Our equipment is state of the art and our screening methods are in accordance with the latest medical literature recommendations and are based on our database of more than 7 million customer results. Our technologists are specialists in their field. They conduct thousands of screenings every year and are exceptionally well-trained. We have an extensive ongoing quality oversight process, including random audits of all clinical procedures. We recognize that the quality of our screenings is the key to your trust and loyalty. I became interested in community vascular screenings during my practice when I saw many patients come into the hospital moribund with ruptured abdominal aortic aneurysms or completed strokes – disasters that could easily have been prevented had the patient known even days before that they had a lurking problem. It also became very apparent to me when talking to my patients with early vascular disease that simply knowing that they had it was often instrumental in changing the very behaviors which were causing their vasculopathies – poor diet, lack of exercise, cigarette smoking, etc. Once the patients knew they were at risk, their family doctors were able to help them change their lifestyles. ����������� And so, our mission at Life Line Screening, since 1993, has been to make people aware of previously undetected health problems and to encourage them to seek follow-up care with their personal physicians. These are problems which are silent, but are discoverable by non-invasive means and treatable. I encourage you to review these results and make an effort to discuss them with your patient. Delivering high-quality and timely results to our customers is of utmost importance to us, but we believe the benefit to the customer is greatly enhanced when coupled with a thorough consultation with their primary care physician. If you have any questions about our services, please feel free to contact me at [email protected]. With warmest collegial regards, PLEASE TURN OVER FOR RESULTS Andrew J. Manganaro, MD, FACS, FACC Chief Medical Officer Life Line Screening SELECTED REFERENCE: Bickel H, Ander H, Bronner M, et al. Reduction of Long-Term Care Dependence After an 8-Year Primary Care Prevention Program for Stroke and Dementia: the INVADE Trial. J Am Heart Assoc 2012, 1: doi: 10.1161/JAHA 112.000786. 13-0207_CLV,10000000 - 1111111111 030513 Test, John Page 18 of 18 Screening Date: February 07, 2013 Location: Immaculate Heart of Mary Parish Center Fasting: Y D.O.B.: 09/26/1947 Life Line Screening Results: Physician Copy John Q. Test Screening Test Measurement Result Left: PSV: < 110cm/s Right: PSV: < 110cm/s No Atrial Fibrillation Detected Heart Rate: 75 Beats/min Risk Category Carotid Artery Disease Blood flow cm/s Atrial Fibrillation 4-Limb EKG Abdominal Aortic Aneurysm cm <3cm Normal Peripheral Arterial Disease Ankle Brachial Index Left Side: 0.86 Right Side: 1.02 Left: Abnormal Right: Normal Osteoporosis Bone Mineral Density -0.5 Low Risk Complete Lipid Panel mg/dL TC: 137 LDL: 62 HDL: 60 Trig: 76 TC: Desirable LDL: Optimal HDL: Protective Against Heart Disease Trig: Normal Glucose mg/dL 146 Diabetes C-Reactive Protein mg/L 0.40 Low Risk Blood Pressure mmHg 198/78 High Stage 2 BMI Body Mass Index 21 Normal Waist Inches 38 Normal Creatinine mg/dL 0.83 Normal 60 Normal 12 Moderate Risk Kidney Heart Risk Assessment eGFR mL/min/1.73 m2 10-yr Heart Risk % Incidental findings Left: Normal Right: Mild Normal 13-0207_CLV,10000000 - 1111111111 030513 Test, John