Coronary heart disease risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: CAD risk factors; risk factors for CAD
Overview
There are many risk factors and risk equivalents associated with coronary heart disease. Risk factors include cigarette smoking, hypertension, a family history of premature coronary artery disease, high LDL cholesterol, low HDL cholesterol, and older age. Some of these risk factors are modifiable, and are good targets for primary prevention in the health care setting.
Risk Factors
Proposed Risk Factor Categories based on the 27th Bethesda Conference[1]
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Category I: Risk factors for which interventions have proved to reduce the incidence of coronary artery disease events such as cigarette smoking, LDL cholesterol, dietary modification, hypertension and thrombogenic factors. Category II: Risk factors for which interventions are likely, based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of coronary artery disease events such as diabetes, physical inactivity, HDL cholesterol, obesity and postmenopausal status. Category III: Risk factors clearly associated with an increase in coronary artery disease risk and which, if modified, might lower the incidence of coronary artery disease events such as psychosocial factors, triglycerides, Lp(a), homocysteine, oxidative stress and alcohol consumption. Category IV: Risk factors associated with increased risk but which cannot be modified or whose modification would be unlikely to change the incidence of coronary artery disease events such as age, gender, family history and many others. |
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Risk Equivalents in Primary Prevention
You are essentially considered to have the equivalent of coronary heart disease if you have any of the following:
- Aortic aneurysm
- Diabetes
- Framingham Risk Score (FRS) of > 20%
- Peripheral vascular disease (PVD) (defined as claudication, an Ankle Brachial Index (ABI) of < 0.9)
- Symptomatic carotid artery disease (defined as prior stroke or TIA)
Cardiovascular Risk Factors in the Setting of Primary Prevention
- Cigarette smoking
- Family history of premature coronary artery disease (CAD)
- High LDL (defined as LDL > 130 mg /dl)
- Hypertension ( defined as a BP ≥140/90 mm Hg or if the patient is on antihypertensive drugs)
- Low HDL (defined as HDL < 40 mg/dL males, < 50 mg/dL in females)
- Older Age (men ≥45 years old; women ≥55 years old)
European Systematic Coronary Risk Evaluation (SCORE) system [2]
- The SCORE project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.
- This system includes both non-modifiable and modifiable coronary risk factors such as:
- to estimate a person’s total ten-year risk of cardiovascular death.
- Patients with established coronary artery disease, diabetics with microalbuminuria, asymptomatic patients with multiple risk factors are considered high-risk for the development of fatal coronary event.
- The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.
Complete List of Cardiac Risk Factors
In alphabetical order: [3] [4]
- ACE DD genotype
- Age
- Chronic Renal Failure
- Cigarette smoking
- Decreased apolipoprotein A1
- Decreased serum folate
- Diabetes Mellitus
- Family history of premature coronary artery disease
- HDL cholesterol < 40 mg/dl
- Hyperhomocysteinemia
- Hypertension
- Hypertriglyceridemia
- Immunosuppressive posttransplant
- Increased apolipoprotein B
- Increased C-reactive protein
- Increased fibrinogen
- Infections
- Insulin resistance syndrome
- Lack of supportive primary relationship
- LDL cholesterol > 130 mg/dl
- Low birth weight
- Metabolic syndrome
- Obesity
- Oral contraceptive use
- Sedentary living
- Syndrome X
- Type A personality
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)[5]
Identification of Patients at Risk (DO NOT EDIT)[5]
| Class I |
| "1. Primary care providers should evaluate the presence and status of control of major risk factors for CHD for all patients at regular intervals (approximately every 3 to 5 years). (Level of Evidence: C)" |
| "2. Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic CHD should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies.[6][7] (Level of Evidence: B)" |
| "3. Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, diabetes mellitus, chronic kidney disease, or 10-year risk greater than 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. (Level of Evidence: A)" |
References
- ↑ Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 27 (5):978-90. PMID: 8609364
- ↑ Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24 (11):987-1003. PMID: 12788299
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ 5.0 5.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE; et al. (2011). "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 123 (18): e426–579. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888.
- ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB; et al. (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines". Circulation. 110 (2): 227–39. doi:10.1161/01.CIR.0000133317.49796.0E. PMID 15249516.
- ↑ National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002). "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. PMID 12485966.