Risk Factors of Atherosclerosis + CHD Flashcards
Non-modifiable risk factors
Age
Gender
Family History- cardiac events before 55 (male relative) or 65 (female relative)
What is the most important risk factor?
Age!
Why are males more likely to have atheroslcerosis?
- Estrogen is protective on blood vessel endothelium
- Men lack estrogen, are more likely to smoke and to have abdominal fat (vs. hip fat)
**after menopause, women’s rate of MI catches up to men
Variables that family history can affect
Dyslipidemia (high LDL, low HDL, high lipoprotein A)
Diabetes
Hypertension
Modifiable Risk Factors
Diet Exercise High LDL Low HDL Smoking Stress Hypertension Abdominal obesity Inflammation
What is the most important thing to prevent the progression to T2DM?
Exercise!!
Factors that damage the epithelium
Aging Smoking Stress High blood pressure High blood sugar High lipoprotein A Inflammation Low HDL
Where does evidence for risk factors come from?
-strengths of the study
INTERHEART study (2004) - all continents, all races, all ages, both genders
Define CHD risk equivalent
-risk factors that are CHD risk equivalents
A patient with CHD risk equivalent has the same risk as someone who is diagnosed with CHD.
Risk factors
- non-cornoary atherosclerosis (e.g. carotid bruit, aortic aneurysm, peripheral artery disease)
- diabetes
- chronic kidney disease
- The most important risk factors according to INTERHEART
- Protective factors
1) Elevated LDL:HDL
2) Smoking
3) Psychosocial (e.g. depression, stress)
4) Diabetes
5) Hypertension
6) Abdominal obesity
1) Daily consumption of fruits + veg
2) Regular physical activity
3) Regular alcohol consumption
Effect of diet on CHD risk
- calorie excess, harmful fats, low fruits/vg, low fiber, processed food all bad
- fruit and veg consumption independently protective
Effect of exercise on CHD risk
- reduces BP
- reduced LDL, increased HDL
- slows progression to T2DM
***don’t have to lose weight for it to help
Definition of dyslipedemia
-how common is inherited dyslipedemia?
- high LDL, low HDL, high triglycerides or some combination of these
- 1/40 people have inherited dyslipidemia
What does HDL do?
- Removes cholesterol from artery wall
- Reduces inflammation
The effect of smoking on CAD risk
- Chemicals from smoke damage endothelium
- immediately on smoking there is vasoconstriction, reduced organ flow
- risk is reduced soon after quitting
The effect of diabetes on CAD risk
- diabetics tend to have higher triglycerides, lower HDL, small dense (harmful) LDL, and high glucose
The effect of abdominal obesity
- the extra fat contains more inflammatory cytokines
Biomarkers for CHD risk
- lipoprotein a
- CRP
Primary prevention targets
- Diet
- Exercise
- Dyslipedemia
- Smoking
- Hypertension
- Stress
Primary prevention with diet includes…
- public education and policy
- dietary assessment
- eating frequently (no skipping meals!)
- More fruit and veg, more fiber, more fish, more chicken, more complex carbs
- less red meat, less processed food, less simple carbs, less harmful fats
Primary prevention with exercise includes…
- Feasible exercise goals
- Frequent exercise
Primary prevention of dyslipedemia…
- Dietary (decrease calories, lower saturated/trans fat, more fiber, fewer simple carbs, plant sterols)
- Treatments: statins and others….
Primary prevention with smoking reduction includes…
- education, public policy (e.g. taxes), bans, warnings
- keep bringing it up with patient
- can do cold turkey or assisted
Primary prevention of hypertension…
- weight loss
- Exercise
- reduction of salt in diet
- medicate
Primary prevention with stress…
encourage stress management: psychotherapy, exercise, meditation etc..
