Nearly all cases of coronary heart disease are caused by atherosclerosis. People with 2 of the risk factors are at high risk of developing CAD. The commonly recognized risk factors for CAD are shown below.
- Age
- Gender/sex
- Race/ethnicity (e.g., South Asian ancestry, is high-risk)
- Family history of CAD (< 55 y in a male or <65 y in a female first-degree relative)
- Hyperlipidemia (tot chol of 200 or more or current tx with lipid-lowering drugs); high LDL, low HDL; Familial hypercholesterolemia
- Diabetes
- Metabolic syndrome
- HTN (BP > 140/90 or current tx)
- CKD
- Inflammatory markers (CRP, IL-6, and myeloperoxidase, etc.)
- Inflammatory/Autoimmune disorders e.g. RA, Ankylosing Spondylosis (AS), Psoriasis, SLE, Vasculitis, etc.
- Lifestyle factors
- Smoking (current or past smoking)
- Obesity
- Physical inactivity / Exercise capacity.
- Diet
- Psychosocial factors: Anxiety/stress, depression, anger, etc are associated w/ ASCVD.
- Alcohol intake. Moderate alcohol intake seems to a protective effect on CHD.
ASCVD Risk Calculator includes many of the above risk factors.
Other CV Risk Factors
- Hypothyroidism.
- Socioeconomic status
- Mediastinal radiation
- HIV infection, Hepatitis C.
- Early menopause and PreEclampsia
CHD Risk Equivalents
- Diabetes.
- CKD
- Noncoronary atherosclerotic arterial disease e.g. PAD, AAA, TIA/stroke of carotid origin, etc.
Manage all patients with a CHD risk equivalent as aggressively as those with prior CHD.
IL-6 = Interleukin-6 seems to play a causal role in CHD
Myeloperoxidase is an enzyme found in WBCs (neutrophils). It is secreted during acute inflammation and promotes oxidation of lipoproteins.
Modifiable risk factors
| Modifiable Risk Factor | Risk Factor and Lifestyle Modifications |
| – Smoking or tobacco use in any form | Screen, counsel, and encourage tobacco cessation. Rx CBT and pharmacotherapy as needed. |
| – Dyslipidemia | Statins as needed to lower cholesterol. Omega-3 fatty acids as needed. A healthy diet, exercise, and weight loss. |
| – Hypertension | Maintain BP JNC 8 goals for the patient’s age. |
| – Diabetes Mellitus or impaired glucose tolerance (IGT) | Treat to keep A1C at goal. Avoid TZDs in patients with HF. |
| – Obesity / Lack of regular physical activity | Exercise at least 150 minutes per week of moderate intensity exercise or 75 minutes of vigorous exercise. Maintain BMI at a goal of 18.5 to 24.9. Cardiac Rehabilitation. |
-Screen and treat depression
-Immunize patients.
Non-modifiable Risk Factors
– Family history of CAD
– Age (male ≥ 35 years and female ≥ 45 years)
– Genetic factor