Stroke Foundation of New Zealand

ClosePreventing Stroke - Self Assessment Chart

Complete our simple Risk for Stroke Self Assessment Test
This test is very basic, if you are concerned about your risk please see your doctor.

Instructions. Select the column with your age group, read the message and if it applies to your personal situation type the Risk Factor number (0, 1, 2 or 3) into the Score box on the right of the table. The Total at the bottom of the form will add up your final score.

Risk Factors	0	1	2	3
Age	0 - 44	45 - 64	65 - 74	75 +
Family History	No strokes known	A relative has had a stroke	A relative has had a stroke while younger than 65 Family history	Several relatives have suffered from a stroke
Diabetes	None known		Family history	Diabeti
Blood Pressure	Normal	Mild high blood pressure	Moderate high blood pressure	Severe high blood pressure
Smoking	Never smoked or quit more than 5 years ago	Quit after smoking for less than five years	Current smoker,less than 20/day	Current smoker more than 20/day
Cholesterol	Below average	Average	Moderately raised	Severely raised
Irregular Heart beat (Atrial Fibrillation)	NO			YES (potentially very high risk add 14 points and see your doctor)
Exercise	1 hour energetic activity at least 3 times/week	Very active once or twice a week	Moderately active once or twice a week	Very little physical activity
Alcohol (Male)	0-2 standard drinks per day	Up to 4 drinks per day	More than 4 drinks twice or more often per week	More than 6 drinks four times or more per week
Alcohol (Female)	0-1 standard drinks per day	Up to 2 drinks per day	More than 2 drinks twice or more often per week	More than 4 drinks four times or more per week
Salt in usual diet	No added salt to diet	Salt added to cooking or to food at the table	Salt added to cooking as well as to food at the table	Salt added to cooking,table food, plus eat salted snacks
Fat in usual daily diet	I avoid all animal fat,including dripping in cooking	Use oils for cooking, low fat milk and cheese, margarine, meat 3-4 times a week	utter,full fat milk and dairy products,fatty meat more than 3-4 times a week and fast foods/takeaways	Butter, high fat cheese, full fat milk and dairy products, fatty meats, bakery items, fast food takeaways
Fruit and vegetables in usual daily diet.	6-8 portions of fruit and vegetables a day	4-5 portions of fruit and vegetables a day	2-3 portions of fruit and vegetables a day	Less than 2 portions of fruit and vegetables a day
				Total:

0 - 5 Very low risk	6 - 10 Moderate risk	11 - 15 High risk	Very high risk

The lower the score the better:
The higher the score the greater your risk of having a stroke.

See your Doctor if you are concerned about your risk of stroke
or want more information.

Stroke Foundation of N.Z. Inc (National office)
P O Box 12482
L1, Federation House
95-99 Molesworth Street
WELLINGTON
Tel: 04 472 8099
0800 STROKE (0800 78 76 53)
E-mail: strokenz@stroke.org.nz

© 2007 New Zealand Stroke Foundation Inc. All Rights Reserved.