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Atherosclerotic Cardiovascular Risk Factors

Learning Objectives To identify modifiable and nonmodifiable risk factors for Atherosclerotic Cardiovascular diseases.

Contents

  • i.

    Risk factors for which intervention has shown to reduce incidence of CAD.

  • ii.

    Risk factors for which Intervention is likely to reduce Incidence of CAD.

  • iii.

    Risk factors for which Intervention might reduce Incidence of CAD.

  • iv.

    Non modifiable Risk factors.

Introduction Coronary Artery Disease (CAD) commonly afflicts adults nowadays in developed as well as developing countries all over the world. It is responsible for an extremely large fraction of hospital admissions among the middleaged and elderly, contributing greatly to disability and death. This chapter outlines the risk factors for CAD and other cardiovascular atherosclerotic diseases.

I Rick factors for which intervention has shown to reduce incidence of CAD

  • 1.

    Cigarette smoking

    • Cigarette smoking has been significantly linked to the occurrence of CAD, and smoking cessation reverses this increased risk within a few years.

    • The adverse impact of cigarette smoking on CAD risk seems to be dose dependent.

    • A mild increase in risk is present among persons passively exposed to smoke.

    • Smoking filtered cigarettes and products low in tar and nicotine is associated with reduced incidence of lung cancer, but favorable effects are not observed for incidence of CAD.

  • 2.

    Low Density lipoproteincholesterol (LDLC)

    • The concentration of total cholesterol or LDLC in the blood is significantly associated with subsequent CAD morbidity and mortality.

    • Several researches have shown that the LDL particle is atherogenic.

    • Extreme elevation of LDLC is the hallmark of familial hypercholesterolemia, a disorder that is associated with LDLreceptors that are abnormal or diminished in number

    • The concentration of LDLC in the plasma is usually about twothirds of the concentration of total cholesterol.

    • A middleaged person with heterozygous familial hypercholesterolemia (affecting 0.2% of the general population), might be expected to have a blood cholesterol concentration of 300450 mgm /dl.

    • Medical therapy can now typically lead to 30% or geater (up to 50%) reduction in LDLC with HMG Co A reductase inhibitors (statins).

    • Recent trials have demonstrated efficacy in the reduction of initial and recurrent CAD events.

    • It has typically taken more than 2 years to observe a favorable effect of LDLC lowering on clinical CAD events, but with more potent LDLC lowering agents especially in higher doses, such a favorable effect may occur sooner.

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