Stroke 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

History of TIA (Transient Ischemic Attack)* Yes No

History of Congestive Heart Failure* Yes No

History of any CVD (Cardiovascular Disease)* 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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