Atherosclerotic Cardiovascular Risk Factors
Learning Objectives To identify modifiable and non‐modifiable risk factors for Atherosclerotic Cardiovascular diseases.
Risk factors for which intervention has shown to reduce incidence of CAD.
Risk factors for which Intervention is likely to reduce Incidence of CAD.
Risk factors for which Intervention might reduce Incidence of CAD.
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 middle‐aged 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
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.
Low Density lipoprotein‐ cholesterol (LDL‐C)
The concentration of total cholesterol or LDL‐C 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 LDL‐C is the hallmark of familial hypercholesterolemia, a disorder that is associated with LDL‐receptors that are abnormal or diminished in number
The concentration of LDL‐C in the plasma is usually about two‐thirds of the concentration of total cholesterol.
A middle‐aged person with heterozygous familial hypercholesterolemia (affecting 0.2% of the general population), might be expected to have a blood cholesterol concentration of 300‐450 mgm /dl.
Medical therapy can now typically lead to 30% or geater (up to 50%) reduction in LDL‐C 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 LDL‐C lowering on clinical CAD events, but with more potent LDL‐C lowering agents especially in higher doses, such a favorable effect may occur sooner.