Risk Factors for Coronary Artery Disease
Scientists and physicians have been able to identify direct and indirect risk factors for the development of cholesterol-based narrowings in the blood vessels that feed the heart muscle, more commonly known as coronary artery disease (CAD). The development of this disease can lead to heart attack, death or chronic disability, and remains the number one killer in the USA today. These risk factors are commonly used by doctors to gauge a patient's risk of developing CAD and following their progress during therapy. Most recently, these factors have become extremely important in the early prevention of this disease.
Blood Cholesterol: The total blood cholesterol of a patient can be divided into the HDL cholesterol (or good cholesterol) and the LDL (or bad cholesterol). A patient's risk of developing CAD can be estimated by these levels. If the patient appears to be at risk or has been diagnosed with CAD, then these levels can be modified by exercise, diet or drug therapy.
Diabetes: Patients with juvenile and adult onset elevated blood sugar are at increased risk for developing early coronary disease. Therefore, it is important to detect this disorder early and manage it carefully with diet, weight loss, and medications, if necessary.
Hypertension: Chronic elevation of the blood pressure has a direct effect on the development of CAD as well as the incidence of stroke. Because this can be a silent disease, it is highly recommended that everyone undergo blood pressure screening every three years. Fortunately, there are a wide range of medications which can control chronic high blood pressure and significantly decrease the risk of stroke and heart disease. Many of these medications, however, can effect the patient's cholesterol and diabetes management. Recently, a class of these medications, called Calcium Channel Blockers, have come under scrutiny for possibly having a higher than normal association with heart attacks. This viewpoint is extremely preliminary and until more conclusive studies are done, these historically very effective antihypertensive medications can be used with caution after discussion with the prescribing physician.
Tobacco: Cigarette, pipe, and cigar smoke continues to be one of the leading toxic public health hazards in our society today. Exposure from personal smoking as well as from other secondary smoke increases the risk and severity of coronary artery disease.
Family History: Patients are considered to be at increased risk for early coronary disease if they have close relatives who have documented disease, prior to the age of 65. Although nothing can be currently done about a person's genetic predisposition, the aggressive management of other modifiable risk factors may become more important.
Gender: Although members of the male sex tend to develop coronary artery disease earlier in life, the female sex's advantage appears to end with the onset of menopause. This protection can be potentially extended with the addition of estrogen replacement therapy in the properly chosen individual. The risk and benefits of this therapy need to be discussed thoroughly with one's personal physician before beginning.
Obesity: There have only been indirect links between the presence of obesity and the development of coronary artery disease. However, the presence of obesity can greatly complicate the management of diabetes, hypertension, and cholesterol abnormalities. Therefore, maintaining ideal weight through diet and regular exercise is strongly recommended.
Review of the cardiac risk factors mentioned above, combined with evaluation of patients' symptoms and a physical exam, allow physicians to counsel patients regarding preventive care or diagnostic testing. Obviously, each of the aforementioned risk factors are important in their own right, but the combination of multiple risk factors can make the prevention and treatment of coronary disease much more challenging.
It is important that whatever level of disease the patient is thought to have, that the diagnosis and treatment of this disorder be a cooperative effort between patient and physician. Hopefully, with the combination of prevention and modification of these risk factors, the incidence of coronary disease will continue to decline.
Robert H. Schwengel, M.D., FACC practices invasive and non-invasive Cardiovascular Medicine with Cardiovascular Associates of Rhode Island in Newport and Providence, RI. He is board certified in Cardiovascular and Internal Medicine, a Fellow of the American College of Cardiology (FACC), and a Clinical Instructor of Medicine at Brown University School of Medicine. He is affiliated with The Miriam Hospital and Newport Hospital.
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