How Is Your Heart?

Heart disease (including hypertension, clogged arteries, heart attacks and strokes) is one of the most pressing health problems affecting African Americans. Real Health wants to know how your heart is doing and what steps you are taking to maintain its health.

Experts suggest walking 10,000 steps a day to build a stronger heart. To help you reach that goal, Real Health is giving away 10 EBF-W03 Multi-Function pedometers ($20 value) from everybodyfit.com, a company that specializes in pedometers and wellness. For more information, visit everybodyfit.com or call 877.438.8365. To enter our drawing, take the following survey. For the official contest rules, visit realhealthmag.com/survey/rules.
 
1. Name:
 
2. Organization (if you represent one):
 
3. Street address:
 
4. City & state:
 
5. ZIP code:
 
6. E-mail:
 
7. Phone:
 
8. When was your most recent physical exam?
Less than six months ago
Six months to one year ago
One to two years ago
More than two years ago
 
9. Do you believe that you are at risk for developing heart disease?
Yes
No
I don't know
 
10. Do you have any of the following heart disease risk factors? (Check all that apply.)
Clogged arteries
Diabetes
High levels of stress
Physical inactivity
Smoking cigarettes
Obesity/being overweight
Consuming a lot of fatty/processed foods
Taking antiretrovirals for HIV disease (HAART)
Taking birth control if you're 35 or older
Family history of heart disease
High blood pressure
High LDL levels ("bad" cholesterol)
Low HDL levels ("good" cholesterol)
None of the above
 
11. Which of the following measures are you taking to help prevent heart disease? (Check all that apply.)
Cutting back on fatty or processed foods
Cutting back on or stopping smoking
Consuming more fruits/vegetables or omega-3 oils
Using stress-reduction techniques (e.g., meditation/yoga/tai chi)
Receiving routine heart, blood pressure and cholesterol screenings
Exercising three or more days a week
Trying to lose weight
None of the above
 
12. Do you know your numbers for the following categories? (Check all that apply.)
High-density lipoprotein (HDL), good cholesterol
Low-density lipoprotein (LDL), bad cholesterol
Blood pressure
Triglycerides
Body Mass Index (BMI)
I don't know any of them
 
13. Have you been diagnosed with or experienced any of the following? (Check all that apply.)
Aneurysm
Angina
Chest tightness
Englarged heart
Heart murmurs
Stroke or ministroke
Discomfort in upper body
Paralysis of one side of body
Peripheral artery disease (PAD)
Problems breathing/shortness of breath
Sudden numbness or weakness of the face, arm or leg
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one/both eyes
Sudden trouble walking/dizziness
Arrhythmia/heart palpitations
Anxiety
Congenital heart disease
Heart attack/failure
Coronary artery disease
Slow heart rhythms
None of the above
 
14. Have you ever had a heart-related procedure or surgery?
Yes
No
 
15. Are you taking any of the following heart-related medications? (Check all that apply.)
Aspirin
Diuretics (water pills)
Nitrates
Calcium channel blockers (Vascor, Sular, Norvasc)
Cholesterol absorption inhibitors (Zetia)
Holistic remedies (Vitamin E supplements, Coenzyme Q10
ACE inhibitors (Vasotec, Zestril, Accupril)
Beta-blockers (Sectral, Corzide, Zebeta)
Statins (Lipitor, Crestor, Lescol)
None of the above
 
16. Do you have health insurance?
Yes, I have private insurance
Yes, through Medicaid/Medicare
No, I am not insured
 
17. What year were you born?
 
18. What is your gender?
Male
Female
Transgender
Other
 
19. What is your household income?
Under $15,000
$15,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 and over