Heart Disease Worksheet

By Burgo, Kate 
March 21, 2017

Heart Disease Worksheet

It's important to get regular checkups and periodic exams, especially when you have cardiovascular disease. Provide the information requested below to find out how well you're managing your condition.

Lipid profile

I had a lipid profile on __________.

A lipid profile is a lab test that measures the amount of certain fats and cholesterol in your blood. High lipid levels can lead to a heart attack or cause your heart disease to worsen. You should have a lipid profile at least once a year.

Discuss your target cholesterol and lipid levels with your healthcare provider.

Blood pressure

My blood pressure is __________.

High blood pressure, also called hypertension, can lead to a heart attack, heart failure, or kidney failure. Blood pressure-lowering medicines can help, but you may also need to make lifestyle changes to achieve the best results. The American Heart Association recommends blood pressure of less than 130/80 mm Hg for people who have heart failure or diabetes. Make sure your blood pressure is checked at every office visit to your healthcare provider.


I talked with my healthcare provider about quitting smoking on __________.

If you smoke, quit. Cigarette smoking is a strong risk factor for heart disease. As soon as you quit, your blood vessels begin to return to normal. Talk with your healthcare provider about ways to help you quit.


I was screened for diabetes on __________.

Have your blood sugar checked every 3 years if your reading is normal. Early detection and treatment of high blood sugar will help prevent complications associated with diabetes.


I talked with my healthcare provider about my medicines on __________.

Medicine can help treat and prevent the progression of heart disease in many people. Talk with your healthcare provider about aspirin, beta-blockers, ACE inhibitors, and statins.

Although these are suggested guidelines for care, please check with your insurance plan for coverage.


March 21, 2017


Eckel, R.H. 013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Circulation (2013) pp. S1-s45, Stone, N. J. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation (2013) pp. s1-s84

Reviewed By:  

Fetterman, Anne, RN, BSN,Kang, Steven, MD