CVD Disease Risk Prediction

Gender* Male Female

Age*

Systolic Blood Pressure (mmHg)*

Diastolic Blood Pressure (mmHg)*

Treatment for Hypertension* Yes No

Current Smoker* Yes No

Diabetes* Yes No

Height (inches)*

Weight (kg)*

Total Cholesterol (mg/dL)*

HDL Cholesterol (mg/dL)*

LDL Cholesterol (mg/dL)*

Micro Albuminuria Yes No

Race* White (non hispanic) Black (non hispanic) Asian or pacific islander Hispanic Other

Central Retinal Artery Equivalent   Not Sure

Hollenhorst Plaque* Yes No Not Sure

Cataract* Yes No Not Sure

MA and HEM* Yes No Not Sure

AV Nicking* Yes No Not Sure

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