Risk Factors for Coronary Heart Disease.

20-12-2006Back to Article

Extensive clinical and statistical studies have over the last 7 decades have identified several factors that increase the risk of coronary heart disease and heart attack. Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Other factors are associated with increased risk of cardiovascular disease, but their significance and prevalence does not contribute as much as the Major risk factors. They're called contributing risk factors. The American Heart Association has identified several risk factors. Some of them can be modified, treated or controlled, and some can't. The more risk factors you have, the greater your chance of developing coronary heart disease

Non Modifiable Major Risk Factors	Modifiable Major Risk Factors
Increasing Age	Tobacco – Smoking / chewing
Male Sex (gender)	High Blood Cholesterol
Heredity (Including Race)	High Blood Pressure
	Physical Inactivity (No Exercise)
	Obesity & Overweight (>BMI)
	Diabetes Mellitus
Other Risk Factors that contribute to Risk
Stressful Lifestyle	Excessive Alcohol
Other Systemic Problems (Renal) or hereditary problems	Increased Homocysteine Apolipoproteins – a & B1
Deceased HDL Cholesterol	Coronary Calcium > 10 (Age specific)

How do these risk factors contribute to increased risk?

Non Modifiable Major Risk Factors.

• Increasing age — Over 83 % of people (world wide are 65 years or older) & 70% of adults (above 60 years) and 15% between (30 – 50 years) in India are who die of coronary heart disease. At older ages, women (post menopausal) who have heart attacks are more likely to die than men within a few weeks from their first heart attack. Ageing cannot be prevented, but timely screening can prevent heart attacks and help live a fully active and comfortable life.

• Male sex (gender) — Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's. So in India men above the age of 40 years and women above the age of 45 years or earlier if menopause sets in early should undergo risk stratification and basic screening.

• Heredity (including Race) — Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and South Asian’s (Indians – 4 times more risk). This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have. Eg: Familial Hypercholesterolemia.

Modifiable Major Risk Factors.

• Tobacco smoke — Smokers' risk of developing coronary heart disease is 2–4 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease; smokers have about twice the risk of nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn't as great as cigarette smokers'. Exposure to other people's smoke increases the risk of heart disease even for nonsmokers.

• Diabetes mellitus — Diabetes very seriously increases your risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. From two-thirds to three-quarters of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. Modern day health care guidelines emphasize to consider a diabetic as one who has already had one heart attack.

• High blood cholesterol — As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. Knowing the facts about cholesterol can reduce your risk for a heart attack or stroke. Cholesterol is just one of the many substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is produced naturally (and can be affected by your family health history), while some of it comes from the food we eat.

  There are two types of cholesterol: “good” and “bad.” It’s important to understand the difference, and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type — or not enough of another — can put you at risk for coronary heart disease, heart attack or stroke.

To keep your cholesterol under control:

• Schedule a screening at least once if a year if normal & 2 times a year if abnormal.
• Eat foods low in cholesterol and saturated fat
• maintain a healthy weight
• exercise regularly
• follow your healthcare professional's advice.

High blood pressure — High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity helps prevent heart and blood vessel disease. The more vigorous the activity, the greater your benefits. However, even moderate-intensity activities help if done regularly and long term. Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.

Obesity and overweight — People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even as few as 10 pounds, you can lower your heart disease risk.

Contributing Modifiable Risk Factors<.

• Stress — Individual response to stress may be a contributing factor. Many scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

• Alcohol — Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine or 12 fl oz of beer. It's not recommended that nondrinkers start using alcohol or that drinkers increase the amount they drink. It must be noted that usually the amount of drinking increases in time and related to stress and other social factors in a changing world.