Making Yourself Indispensable At Work

Scared of losing your job? Are you living in constant fear of being unemployed owing to the current economic crisis and the ensuing downsizing? Then you are among the millions of employees worldwide, who are living under this continuous threat and wish they could somehow make sure that they were truly indispensable for the company. While it is true that no one is completely indispensable, there are certain things that you can do to make yourself a valuable employee so that the company managers have to think twice before letting you go. Here are some tips that you can incorporate in your daily routine to lessen the chances of you getting fired in the next downsizing:

Take more initiative

The most important thing in a workplace is taking initiative, not only because of the downsizing, but also because of the constantly changing job conditions. Nobody appreciates an employee who sits around waiting to be told what to do next and then accomplishes only the given task. Be active and take every opportunity that comes your way.

Work hard

When you are being paid to do something, you are supposed to give it your maximum effort. In order to become indispensable you must make sure that you are doing your work well and are meeting the required standards. Not only that, to prove to your employers that you are a worthy asset; you have to excel in your work and go beyond the expected standards. Moreover, if you do not know how to do something, instead of making it an excuse, go and find out how to go about that specific task and finish it efficiently.

Take responsibility

In order to become an asset for your company you will have to go beyond your job description and start viewing your department as a company, and yourself as the sole owner of the company. You must consider the pros and cons of every decision you make. At the end of the day, you must think of ways to improve the output of your department in order to impress the superiors with your productivity.

Positive attitude

Whatever happens, try to stay calm and focused. Maintaining a positive attitude in workplace is essential in proving your worth. An employee, who gets panicked easily and starts messing things up, is not an indispensable asset. If you can accomplish your tasks on a rough day with a smile on your face, you will definitely get noticed by your superiors and will certainly make a good impression.

Be a team player

Make sure that you are a valuable team player by always supporting your superiors and your entire team. Moreover, you have should remain careful and steer clear of petty politics and other unprofessional stuff that can retard the pace of work and harm the ongoing projects. Choose to be an integral part of any team and be responsible for the work allotted to you. Work in such a manner that your team and your managers start depending on you and start considering you indispensable.

Avoid politics

No matter which company you work for, office politics will follow you and getting involved means getting into trouble. So, the best option is to avoid taking sides whenever such a situation arises in the workplace. You never know what the consequences of such actions might be. Just be neutral and try to get along well with everyone. Moreover, do not indulge in gossip under any circumstances and distance yourself from such conversations regarding rumors about the company. It is important that you have a clean reputation and are not regarded as a tale-bearer in the eyes of your superiors. Remember, no one wants to have a gossiping employee or a team mate, who can’t keep things confidential.

Improve your skills

In order to make yourself indispensable in the eyes of your managers, you should focus on the specific skills that you possess. While it is important that you possess a specialized skill, what is more important is how effectively you utilize this skill. Make sure that you let your superiors know that you are willing and available to help whenever your expertise is needed. This will make you a valuable resource, and an indispensable person within the organization.

Improve your visibility

While it is vital that you do your work with honesty and dedication, it is more important that you make people aware of your achievements and expertise without being ostentatious. Keep your superiors apprised of your efforts and hard work in terms of benefiting the company.

Be prepared to volunteer

Make sure that whenever you get the chance, you volunteer to do extra work in order to save your employer money and time. Nothing is more crucial for the managers than saving time and money. By volunteering to do extra projects, you can impress more people in the office with your capabilities and talent.

Be flexible

Make sure that you can be flexible enough to adapt changes smoothly. Due to the ongoing economic crisis many companies are constantly making integral changes in their organization to save resources and be more productive. If you cannot go with the changes and do your best to ensure a smooth transition, sooner or later your superiors will start considering you a burden for the team and you will be replaced.

Be cost effective

Nowadays cutting costs has become a major concern for most organizations, which means that as a valuable employee you should concentrate on finding ways to help lower the cost in your company. Make a note of the cost savings you have achieved and make sure to keep the management informed about your efforts in this regards.

Manage your time

Make sure that you get to work on time and don’t be the first one to rush out the door as soon as your time ends. This is the way your employers and managers assess your dedication and commitment to your job. Any company will value an employee who shows up for work punctually and exhibits concern over his job. Moreover, keep in mind that your employers will also know if you are just wasting time by sitting idle at your work station, only to spend extra time in office to impress the boss. So whatever you do, make sure that your work output is in balance with the time you spend at the office.

Managed Health Care Plans

What is managed health care?

It’s a system that controls the financing and delivery of health services to members who are enrolled in a specific type of healthcare plan.

The goals of managed health care are to ensure that...

• providers deliver high-quality care in an environment that manages or controls costs.
• the care delivered is medically necessary and appropriate for the patient’s condition.
• care is rendered by the most appropriate provider.
• care is rendered in the most appropriate, least-restrictive setting.

What are the major types of managed care plans?

• Health Maintenance Organizations (HMO)
• Preferred Provider Organizations (PPO)
• Point-of-Service (POS) plans

Each of these systems has distinctive features or characteristics.

Health Maintenance Organizations (HMO)

• An HMO enters into contractual arrangements with healthcare providers (e.g., physicians, hospitals and other healthcare professionals) who together form a “provider network.” In simple terms, a contracted provider is one who provides services to health plan members at discounted rates in exchange for receiving health plan referrals.
• Members are required to see only providers within this network to have their healthcare paid for by the HMO. If the member receives care from a provider who isn’t in the network, the HMO won’t pay for care unless it was pre-authorized by the HMO or deemed an emergency.
• Members select a Primary Care Physician (PCP), often called a “gatekeeper,” who provides, arranges, coordinates and authorizes all aspects of the member’s health care. PCPs are usually family doctors, internal medicine doctors, general practitioners and obstetricians/gynecologists.
• Members can only see a specialist (e.g., cardiologist, dermatologist, rheumatologist) if this is authorized by the PCP. If the member sees a specialist without a referral, the HMO won’t pay for the care.
• HMOs are the most restrictive type of health plan because they give members the least choice in selecting a health care provider. However, HMOs typically provide members with a greater range of health benefits for the lowest out-of-pocket expenses, such as either no or a very low copayment (the amount of money a member is required to pay the provider in addition to what the HMO pays. It often must be paid prior to services being rendered).

Preferred Provider Organizations (PPO)

• PPOs are similar to HMOs in that they enter into contractual arrangements with healthcare providers (e.g., physicians, hospitals and other healthcare professionals) who together form a “provider network.”
• Unlike an HMO, members don’t have a PCP (“gatekeeper”) nor do they have to use an in-network provider for their care. However, PPOs offer members "richer" benefits as financial incentives to use network providers. The incentives may include lower deductibles, lower co-payments and higher reimbursements. For example, if you see an in-network family physician for a routine visit, you may only have a small co-payment or deductible. If you see a non-network family physician for a routine visit, you may have to pay as much as 50 percent of the total bill.
• PPO members typically don’t have to get a referral to see a specialist. However, as mentioned above, there’s a financial incentive to use a specialist on the PPO’s provider network.
• PPOs are less restrictive than HMOs in the choice of health care provider. However, they tend to require greater "out-of-pocket" payments from the members.

Point-Of-Service Plans (POS)

• A POS plan is often called an HMO/PPO hybrid or an “open-ended” HMO. The reason it’s called “point-of-service” is that members choose which option – HMO or PPO – they will use each time they seek health care.
• Like an HMO and a PPO, a POS plan has a contracted provider network.
• POS plans encourage, but don’t require, members to choose a primary care physician (PCP). As in a traditional HMO, the PCP acts as a “gatekeeper” when making referrals. Members who choose not to use their PCPs for referrals (but still seek care from an in-network provider) still receive benefits but will pay higher copays and/or deductibles than members who use their PCPs.
• POS members also may opt to visit an out-of-network provider at their discretion. If so, a member copays, and coinsurance and deductibles are substantially higher.
• POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.

Get More Done Every Day With Effective Time Management

Do you often feel like you have too much work on your hands and are regularly exhausted at work?Your co-workers have the same amount of work as you, but they seem to fly through it while you have to push your limits just to make the deadlines. However, this does not necessarily mean that you are bad at your job or that you are less talented than your colleagues. If, most of the time, you fail to meet your deadlines and are unable to perform your everyday duties within the time then you are basically having problems in managing your time properly. Time management is the key to success in your professional and personal life.

Tips for effective time management

The better you are at managing your time, the more your output increases. Here are a few simple tips that will help you in managing your time more effectively.

Be Organized

Being organized is of prime importance in managing time properly. In this regard, proper file management and maintenance is of essence. Make sure that all your files are properly labeled and stored in whatever order that suits you best. If you have to spend 5 to 10 minutes looking for the right files every time you need them, you are obviously going to fall behind your schedule. It is always better to keep and maintain your files in the computer as they are easy to access and edit.

Develop your pace

Everyone has a different pace and momentum that works for them. It is always better to work at your natural pace and try to organize your schedule around it so that you can perform all your daily chores without feeling exhausted.

Be prepared

Always be prepared to take notes and record important observations that might help you with your work later on. It might happen that you think of something that can be vital for your work, but you cannot note it down only because you do not have a pen and pad with you. There is a high probability that you might not remember that point later on and waste a lot of time trying to remember what it was.

Set your priorities

You have to be able to organize your tasks in the order of their priority. You cannot take care of all the tasks at the same time, and not all the jobs at hand need to be taken care of at once. It is better to organize the tasks in the order of their priority and then get to them one by one. However, try to make sure that you finish all your daily tasks before the day ends; otherwise, the incomplete work will pile on to the next day and further upset your daily schedule.

Stick to the timetable

Develop a timetable that works for you, and make sure that you stick to the timetable as much as possible. Avoid making room for additional chores since that will only add to your workload and you will end up accomplishing far less than what you had originally hoped for. Also, remember to update the timetable at the end of the day in order to cater to the workload of the next day. If you leave it to the next day, a lot of time will be wasted and will decrease your efficiency.

Avoid interruptions

Constant interruptions delay your work more than anything. Whenever the phone rings, an email arrives or a colleague comes over to talk to you, your concentration breaks and your work suffers. When you get distracted, it is very hard to pick up the pace from where you left it. So, when you start working, make sure that there are minimum interruptions around you. Put off the email alert so that you are not disturbed whenever an email comes in, and let your colleagues know that you are working on an important project and would appreciate minimum distractions. This way you can work at your maximum potential without seeming rude to your co-workers.

Delegate your work

It is important to understand that you cannot take care of all the work by yourself, no matter how talented or efficient you are. You should be able to identify when you need to stop and ask someone for assistance. This not only helps in getting your work done on time but also helps in maintaining the quality of work. If you try to complete all the work yourself, you might be able to meet the deadlines but there are high chances that you might make mistakes, and ultimately, the quality of work will suffer.

Make a checklist

Make sure that you have a checklist of all the tasks that need to be taken care of by the end of the day. Keep the checklist in plain sight, and keep referring to it from time to time to monitor your progress. Again, it is helpful to compile the checklist in accordance with the level of priority of the task at hand. This way, when you start ticking the high priority tasks on the list, your stress level decreases with every task that you accomplish.

One thing at a time

While multitasking is an asset in many instances, it is not so helpful in effective time management. If you concentrate on one task at a time, you have better chances of achieving your goals. The most time effective way is to pick a task from the check list, start working on it and move to the next task only when you have completed the first one. Remember, in a workplace, every task needs your complete attention, and sometime, even a small mistake can lead to trouble.

Time tracking

One of the most important things that matter in effective time management is keeping track of your time. Many times, you get so engrossed in your work that you lose the track of time and might spend too much time on one job, while the others suffer. Make sure that you are aware of the time you spend on one job, by allocating a specific time bracket for that task, and then try to finish it in time.

Conclusion

Hopefully, these suggestions will help you in effectively managing your time and will increase your output considerably. Remember, time is of essence, especially in the professional field, so do everything in your power to make the most of it.

Integrating prevention into health care

Due to public health successes, populations are ageing and increasingly, people are living with one or more chronic conditions for decades. This places new, long-term demands on health care systems. Not only are chronic conditions projected to be the leading cause of disability throughout the world by the year 2020; if not successfully prevented and managed, they will become the most expensive problems faced by our health care systems. People with diabetes, for example, generate health care costs that are two to three times those without the condition, and in Latin America the costs of lost production due to diabetes are estimated to be five times the direct health care costs. In this respect, chronic conditions pose a threat to all countries from a health and economic standpoint.

Many costly and disabling conditions - cardiovascular diseases, cancer, diabetes and chronic respiratory diseases - are linked by common preventable risk factors. Tobacco use, prolonged, unhealthy nutrition, physical inactivity, and excessive alcohol use are major causes and risk factors for these conditions. Trends in tobacco use will increase in the foreseeable future especially in developing countries. The ongoing nutritional transition expressed through increased consumption of high fat and high salt food products will contribute to the rising burden of heart disease, stroke, obesity and diabetes. Changes in activity patterns as a consequence of the rise of motorised transport, sedentary leisure time activities such as television watching will lead to physical inactivity in all but the poorest populations. Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.

CURRENT SYSTEMS OF HEALTH CARE

Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.

Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.

HOW CAN HEALTH SYSTEMS RESPOND TO THIS CHALLENGE?

Given that many conditions are preventable, every health care interaction should include prevention support. When patients are systematically provided with information and skills to reduce health risks, they are more likely to reduce substance use, to stop using tobacco products, to practice safe sex, to eat healthy foods, and to engage in physical activity. These risk reducing behaviours can dramatically reduce the long-term burden and health care demands of chronic conditions. To promote prevention in health care, awareness raising is crucial to promote a change in thinking and to stimulate the commitment and action of patients and families, health care teams, communities, and policy-makers.

A collaborative management approach at the primary health care level with patients, their families and other health care actors is a must to effectively prevent many major contributors to the burden of disease.

Essential elements for action

• Support a paradigm shift towards integrated, preventive health care
• Promote financing systems and policies that support prevention in health care
• Equip patients with needed information, motivation, and skills in prevention and self-management
• Make prevention an element of every health care interaction

WHO'S RESPONSE

WHO's Non-communicable Diseases and Mental Health cluster has created a new framework for assisting countries to reorganize their health care for more effective and efficient prevention and management of chronic conditions. The Innovative Care for Chronic Conditions Framework is centred on the idea that optimal outcomes occur when a health care triad is formed. This triad is a partnership among patients and families, health care teams, and community supporters that functions at its best when each member is informed, motivated, and prepared to manage their health, and communicates and collaborates with the other members of the triad. The triad is influenced and supported by the larger health care organization, the broader community, and the policy environment. When the integration of the components is optimal, the patient and family become active participants in their care, supported by the community and the health care team.

EXAMPLES OF INNOVATION FROM AROUND THE WORLD

The following three case studies demonstrate successful implementation of one or more components of prevention in health care.

Brazil: Establishing preventive health services in low resource communities

Cearà, a poor state in Brazil presents a model of care that may be achievable for other countries in which resources, income, and education levels are limited. In 1987, auxiliary health workers, supervised by trained nurses (one nurse to 30 health workers) and living in local communities, initiated once-monthly home visits to families to provide several essential health services. The programme was successful in improving child health status and vaccinations, prenatal care, and cancer screening in women. It was low cost, too. Salaries for the heath workers were normal wage, few medications were used and no physicians were included. Overall, the programme used a very small portion of the state’s health care budget.

In 1994, the health worker programme integrated into the Family Health Programme that includes physicians and nurses on the team with the health workers. For the first time in Brazil, large scale integrated, preventive health services were in place.

Svitone, EC, Garfield, R, Vasconcelos, MI, & Craveiro, VA Primary health care lessons for the Northeast of Brazil: the Agentes de Saude Program, Pan Am J Public Health 2000;7(5):293-301.

USA: Incorporating prevention into primary care

Kaiser Permanente, a large managed care organization in California, recently reoriented its primary care clinics to better meet the needs of patients, emphasizing the needs of those with chronic conditions. Multidisciplinary teams were created that include physicians, nurses, health educators, psychologists, and physical therapists. These primary care teams link with pharmacy, the telephone advice and appointment centre, chronic conditions management programmes, and specialist clinics creating a totally integrated system of care from outpatient clinics to inpatient hospital care.

Patients are enrolled in the chronic conditions management programs via outreach strategies that identify those with chronic conditions who have not sought primary care, and through physician identification during primary care office visits. Patients receive services from multiple disciplines, based on the intensity of their needs. The diagram depicts the three levels of care. There is an emphasis on prevention, patient education, and self-management. Non-physician team members facilitate group appointments. Biological indices have improved across conditions such as heart disease, asthma, and diabetes. Screening and prevention services have increased and hospital admission rates have declined.

A recent comparison of Kaiser’s integrated care system with the UK’s National Health System found that although costs per capita in each system were similar, Kaiser’s performance was considerably better in terms of access, treatment, and waiting times. Explanations for Kaiser’s better performance included real integration across all components of health care, treating patients at the most cost-effective level of care, market competition, and advanced information systems.

Feachem GA, Sekhri NK, & White KL. Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanente. British Medical Journal 2002;324:135-143

India: Integrating non-communicable disease prevention and management

Cardiovascular and cerebrovascular diseases, diabetes, and cancer are emerging as major public health problems in India. Apart from a rising proportion of older adults, population exposure to risks associated with certain chronic conditions is increasing. Obesity is increasing, physical activity is declining, and tobacco use is a substantial problem in the country.

Although it is commonly believed that non-communicable diseases (NCDs) are more prevalent in higher income groups, data from India’s 1995-1996 national survey showed that tobacco intake and alcohol misuse are higher in the poorest 20% of the income quintile. As a result, the government of India is anticipating that the prevalence of tobacco-related conditions will increase in lower socio-economic groups in the coming years.

The government has adopted an integrated NCD prevention and management programme. The main components of this programme are:

• Health education for primary and secondary prevention of NCDs through mobilizing community action;
• Development of treatment protocols for education and training of physicians in the prevention and management of NCDs;
• Strengthening/creation of facilities for the diagnosis and treatment of CVD and stroke, and the establishment of referral linkages;
• Promotion of the production of affordable drugs to combat diabetes, hypertension, and myocardial infarction;
• Development and support of institutions for the rehabilitation of people with disabilities;
• Research support for: Multisectoral population-based interventions to reduce risk factors;
• The role of nutrition and lifestyle-related factors;
• The development of cost effective interventions at each level of care.

Planning Commission, India, 2002.

CONCLUSION

• Many of the costly and disabling conditions facing health systems today can be prevented. Additionally, with proper support many of their complications can be averted or delayed.
• Strategies for reducing onset and complications include early detection, increasing physical activity, reducing tobacco use, and limiting prolonged, unhealthy nutrition.
• Through innovation, health care systems can maximize their returns from scarce and seemingly non-existent resources by shifting towards activities that emphasize prevention and delay in complications.
• Small steps are as important as system overhaul. Those who initiate change, large or small, are experiencing benefits today and creating the foundation for success in the future.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222

CIA Hosts Drink and Dance Party For Pakistani Journalists at US Embassy Islamabad

CIA Public Relations at work? Do you expect this “Pakistani media” would tell you the truth and serves the interests of Islam and Pakistan? If you still believe that then may Allah help you and show you the righteous path before its too late for all of us.

Update: PTV Suspends Two Journalists For Attending US Embassy CIA Party

Shaukat Paracha, Asma Shirazi, Meher Bukhari, Saima Mohsin are some of the names that were in attendance, in a Drink & Dance party hosted by the US Ambassador to Pakistan, Anne W Patterson.

More photos from the event below:

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Terrorism: How CIA Incapacitates Pakistan

An Open Letter To The Pakistani Media – How Far Will You Go?

Dr. Mahru Khalid

As I sit in my room writing this, I can hear Indian music playing on the television outside. I know that it is a Pakistani channel,and I can hear snatches of people singing praises of how wonderful Indian music and artists are. It has been going on for the last2 hours and may as well go on for another 2. This is what I have come to expect from my country’s media.

I refuse to go outside and watch that. Because, you see, I’m more intrigued by a news channel telling us how truckloads of Indian ammunition are being discovered by the Pak army in South Waziristan, by someone revealing how the Takfiri TTP are being financed by Indo-American (and other foreign) forces, and how names like Blackwater, Xe, DynaCorp., are raising their ugly heads andinfiltrating into the Pakistani society. Rather than watching Indian movies, I’m more entertained when I go on the internet and readstories of how Mumbai investigator Mr. Hemant Karkare was silenced forever because he could have spilled the beans that Mumbai was an inside job, how the militants who carried out that attack had stayed at a guest house called Nariman House for several days before the attack, and where they were provided food, ammunition, and arms in full knowledge of the Mumbai police, how the 40,000 strong Mumbai police was deliberately kept away from the scene of the shooting, as the terrorists went about their merry way killing people. All this from the pen of a respected Indian writer, Mr. Amaresh Mishra, for me, beats the most smoothly done Indian movieanyday!

I haven’t forgotten 26/11, and its aftermath, when your Indian counterparts didn’t bother to think rationally for a second, and pointed the finger squarely at us, how they threatened people like Adnan Sami Khan to leave or suffer the consequences, how Pakistani contestants were ejected from TV shows. I haven’t forgotten how united the Indian media and people were in their hate, or how vocal the media was with its hate-filled remarks, which were sometimes shocking in their intensity, and all on the basis of mere suspicion. And then, with much regret, I haven’t forgotten the insensitive way you responded to this outburst. Some of you even went as faras to claim that Ajmal Qasab is indeed a Pakistani citizen from Faridkot, a claim that has now been refuted by Qasab himself.

Fake Evidence: Faridkot Residents Protest!

Video: Geo Tv Report on Ajmal Kassab – The Reality

PSYCHOLOGICAL OPERATIONS: Close Down GEO TV and Everything Will be Fine

And now, a year later, I see my own country bleeding like it has never bled before. I remember the horror of Marriott, the shock of Lahore’s attack on the Sri Lankan cricket team, the valour of the Shaheeds of Swat and Waziristan. This nation will never forget the innocent Shaheeds of GHQ, Peshawar, Parade Lane, Moon Market, and so many other places. Our innocent brothers, sisters, sons, daughters were this nation’s wealth, they were a part of its future, and a legacy of its past. We have lost some of our gems, but we will never lose the will to avenge each and every drop of innocent blood.

Now I ask you, Pakistani media, do you not see who is behind all this? Don’t the daily deaths mean anything to you? Do you not seethe huge gaping wound? I want to ask you, how far will you go in this Indian admiration of yours? I see morning shows competing with each other in getting the biggest Indian star on the show. I change the channel and I see a senseless but box-office rich Indian movie being shown. I go further and I see barely clad women dancing in a spot advertising the latest Indian awards. Can you not see anything beyond the mindlessness of Indian entertainment?

Can you see that they are out to destroy us from within, to eat our society up like termites eat wood? I can almost imagine them wringing their hands with contentment at our political and moral degradation, at how they maneuvered things until we were deprived of hosting any cricketing event on our soil. Why don’t you admire the smooth precision with which they accomplished these ugly goals?

Your silence is deafening, your silence on this geo-political war being waged on Pakistan, your silence when Ajmal Qasab said he’s just an Indian being directed in the greatest Indian drama ever played, your silence on the menacing involvement of Indian intelligence agencies in supporting terrorism in Pakistan. Your silence is truly deafening. Instead, you seem smitten by the very forces who want to see Pakistan on its knees.

Will you still go on dancing to their tunes? Will you still go on leading the people of this nation further into fools’ paradise? I just wonder, how far will you go?

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Risk Factors and Coronary Heart Disease and Stroke

American Heart Association scientific position
Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. Major risk factors are those that medical research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Contributing risk factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven’t yet been precisely determined.

The American Heart Association has identified several risk factors for coronary heart disease. Some of them can be modified, treated or controlled, and some can’t. The more risk factors a person has, the greater the chance that he or she will develop heart disease. Also, the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 240 mg/dL, even though all people with a total cholesterol of 240 or higher are considered high risk.

What are the major uncontrollable risk factors for coronary heart disease?

Increasing age — About 82% of people who die of coronary heart disease are 65 or older.

Male sex (gender) — The lifetime risk of developing CHD after age 40 is 49% for men and 32% for women. The incidence of CHD in women lags behind men by 10 years for total CHD and by 20 years for more serious clinical events such as MI and sudden death.

Heredity (including Race) — Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have.

Other major risk factors that can be lowered by modification, treatment or control.

Tobacco smoke — Smokers’ risk of developing CHD is two to four times that of nonsmokers'. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as cigarette smokers'. Constant exposure to other people's smoke — called environmental tobacco smoke, secondhand smoke or passive smoking — increases the risk of heart disease even for nonsmokers.

High blood cholesterol levels — The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet.

High blood pressure — High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.

Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity is important in preventing heart and blood vessel disease. Even moderate-intensity physical activities are beneficial if done regularly and long-term. More vigorous activities are associated with more benefits. Physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure.

Obesity and overweight — People who have excess body fat — especially if a lot of it is in the waist area — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart, raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (good) cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people have difficulty losing weight. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.

Diabetes mellitus — Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. From two-thirds to three-quarters of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's important to work with your healthcare provider to manage your diabetes and control any other risk factors you can.

What other factors contribute to heart disease risk?

Stress — Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

Sex hormones — These seem to play a role in heart disease. It’s well known that men have more heart attacks than women do before the age of menopause. Several population studies show that the loss of natural estrogen as women age may contribute to a higher risk of heart disease after menopause. If menopause is caused by surgery to remove the uterus and ovaries, the risk of heart attack rises sharply. If menopause occurs naturally, the risk rises more slowly. Hormones also affect blood cholesterol. Female hormones tend to raise HDL ("good") cholesterol and lower total blood cholesterol. Male hormones do the opposite.

Birth control pills — The early forms, with higher doses of estrogen and progestin, increased a woman’s risk of heart disease and stroke, especially in older women who smoked heavily. Newer, lower-dose oral contraceptives carry a much lower risk of cardiovascular disease, except for women who smoke or have high blood pressure. If a woman taking oral contraceptives has other risk factors (and especially if she smokes), her risk of developing blood clots and having a heart attack goes up. It rises even more after age 35. Women with a history of heart disease don't benefit in reducing further heart attacks by taking hormone replacement therapy (HRT).

Excessive alcohol intake — Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It also contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1–1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. It’snot recommended that nondrinkers start using alcohol or that drinkers increase their intake.

Stroke risk factors

The American Heart Association has identified several factors that increase the risk of stroke. The more risk factors a person has, the greater the chance that he or she will have a stroke. Some of these you can’t control, such as increasing age, family health history, race and gender. But you can modify, treat or control most risk factors to lower your risk of stroke. Factors resulting from lifestyle or environment can be modified with a healthcare provider's help.

What are the risk factors for stroke?

Increasing age — The chance of having a stroke about doubles for each decade of life after age 55. While stroke is common among the elderly, over 25 percent of people who have strokes are under age 65.

Sex (gender) — Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. At older ages, the incidence is higher in women than in men. Overall, more women than men die of stroke.

Heredity (family history) and race — The chance of stroke is greater in people who have a family history of stroke. African Americans have a much higher risk of disability and death from a stroke than whites, in part because blacks have high blood pressure and diabetes more often. Asian/Pacific Islanders and Hispanics also have a high risk of stroke.

Prior stroke — The risk of stroke for someone who has already had one is many times that of a person who has not.

High blood pressure — High blood pressure is defined in an adult as a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher or taking antihypertensive medicine; or having been told at least twice by a physician or other health professional that one has HBP. It's a major risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.

Cigarette smoking — Cigarette smoking is an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. Using birth control pills and smoking cigarettes greatly increases stroke risk.

Diabetes mellitus — Diabetes is an independent risk factor for stroke and is strongly correlated with high blood pressure. While diabetes is treatable, having it still increases a person’s risk of stroke. People with diabetes often also have high cholesterol and are overweight, increasing their risk even more.

Heart disease — A diseased heart increases the risk of stroke. The percentage of people with a first myocardial infarction who will have a stroke within five years at ages 40–69 is 4 percent of men and 12 percent of women. At age 70 and older, 6 percent of men and 11 percent of women will have a stroke after having a heart attack. Atrial fibrillation (the rapid, uncoordinated quivering of the heart’s upper chambers), in particular, raises the risk for stroke. Heart attack is also the major cause of death among stroke survivors.

Transient ischemic attacks (TIAs) — TIAs are "mini strokes" that produce stroke-like symptoms but no lasting damage. They're strong predictors of stroke. Approximately 15% of all strokes are heralded by a TIA.

High red blood cell count — A moderate or marked increase in the red blood cell count is a risk factor for stroke. The reason is that more red blood cells thicken the blood and make clots more likely.

Sickle cell anemia — This genetic disorder mainly affects African-American and Hispanic children. "Sickled" red blood cells are less able to carry oxygen to the body’s tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

What other factors can affect the risk of stroke?

Socioeconomic factors — There’s some evidence that people of lower income and educational levels have a higher risk for stroke.

Excessive alcohol intake — Excessive drinking (an average of more than one drink per day for women and more than two drinks per day for men) and binge drinking can lead to stroke. It can also raise blood pressure, contribute to obesity, high triglycerides, cancer and other diseases, and cause heart failure.

Certain kinds of drug abuse — Intravenous drug abuse carries a high risk of stroke from a cerebral embolism (blood clot in the brain). Cocaine use has been closely related to strokes, heart attacks and a variety of other cardiovascular complications. Some of them have been fatal even in first-time cocaine users.

How are heart disease risk factors related to stroke?

Some risk factors affect the risk of stroke indirectly by increasing the risk of heart disease. These secondary risk factors include:

• High blood cholesterol and triglycerides
• Physical inactivity
• Obesity or overweight