Heart Disease Worksheet

It's important to get regular checkups and exams, especially when you have heart disease. Fill in the information 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 they can cause your heart disease to get worse. Have a lipid profile done at least once a year. You may need this test more often if you are at risk for another disease, such as diabetes. Your healthcare provider will tell you how often to have this test.

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

Blood pressure

My blood pressure is __________.

High blood pressure (hypertension) can lead to a heart attack, heart failure, or kidney failure. Medicines can help lower your blood pressure. But you may also need to make lifestyle changes to reach your blood pressure goal. The American Heart Association advises a blood pressure of less than 130/80 mm Hg for people who have heart failure or diabetes. Elevated blood pressure begins at 120/80 mm Hg. Have your blood pressure checked at every office visit to your healthcare provider.


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

If you smoke, get help to quit. Cigarette smoking is a strong risk factor for heart disease. As soon as you quit, your blood vessels begin to return to normal. Quitting smoking is the single most important thing you can do to prevent heart disease. 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 linked to diabetes. Have your blood sugar level checked more often if you are at risk for diabetes.


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

Medicine can help treat heart disease and prevent it from getting worse. Talk with your healthcare provider about aspirin, diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, statins, and SGLT2 inhibitors.

These are suggested guidelines for care. Check with your insurance plan to see if this care is covered.

Physical activity

I talked with my healthcare provider about my physical activity on __________.

For adults, experts recommend 30 minutes of physical activity on most days. Aim for a total of 150 or more minutes a week. Not sure you can fit one 30-minute block of exercise time into your day? Split it up into shorter 10- and 15-minute blocks. Do this 2 to 3 times a day. You'll still get all the benefits of exercise. Adults who have two or more diseases at the same time might be limited with their exercise. They should stay as physically active as their condition allows. Check with your healthcare provider before beginning an exercise program.

Online Medical Reviewer: Stacey Wojcik MBA BSN RN
Online Medical Reviewer: Steven Kang MD
Online Medical Reviewer: Tennille Dozier RN BSN RDMS
Date Last Reviewed: 7/1/2023
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