RISK FACTOR FOR RISK FACTOR FOR CORONARY ARTERY CORONARY ARTERY

DISEASEDISEASE

RISK FACTOR FOR RISK FACTOR FOR CORONARY ARTERY CORONARY ARTERY

DISEASEDISEASE

Dr.Animesh Mishra; MD (BHU), DM (Delhi Dr.Animesh Mishra; MD (BHU), DM (Delhi University). University).

Associate Professor, Department of cardiologyAssociate Professor, Department of cardiologyNEIGRIHMS,Shillong-12NEIGRIHMS,Shillong-12

PURPOSE OF THIS VEDIO-CONFERENCING

Dissemination of information relative to the prevention

of atherosclerosis and its adverse consequences. Development of educational pro-grams specific to

the role of the cardiovascular specialist with regard to prevention. Cooperative development of practice guidelines, for consultative as well as rehabilitation services, to deliver cost-effective preventive care. Policies of fair reim-bursement for effective services. Participation in the assessment of clinical outcomes

of such programs.

Cont.... To promote preventive cardiac care by

Endorsing anti-smoking policies & programs. Encouraging healthy dietary behavior. Promoting prudent physical activity. Ensuring adequate control of blood pressure. Managing patients with hyperlipidemia, metabolic, coagulative and other risk factors. Advising primary care physicians with regard

to risk reduction. Developing a cardiovascular health promotion

plan for cardiac patients and their families.

Definition of CHD Framingham definition: Angina

pectoris, recognized and unrecognized MI,USA,& CHD deaths.

Recent Framingham report :“Hard" CHD excludes angina pectoris.)

(AFCAPS/Tex CAPS): Specified acute coronary events as USA, AMI & coronary death.

Major Independent Risk Factors

AHA/ACC Scientific Statement: Cigarette smoking

Elevated blood pressureElevated serum total (and LDL) cholesterolLow serum HDL cholesterolDiabetes mellitusAdvancing age

Other Risk Factors

Predisposing risk factors   Obesity   Abdominal obesity   Physical inactivity   Family history of premature coronary heart

disease   Ethnic characteristics   Psychosocial factors

*These risk factors are defined as major risk factors by the AHA .

Cont….

Conditional risk factors

   Elevated serum triglycerides   Small LDL particles   Elevated serum homocysteine   Elevated serum lipoprotein (a)   Prothrombotic factors (eg, fibrinogen)   Inflammatory markers (eg, C-reactive protein)

MENTAL STRESS,DEPRESSION,AND CARDIOVASCULAR RISK

From Clinician’s perspective-As a modifiable risk factor

1- Acute stress 2- Work related stress (a)-Job strain (b)-Effort-reward imbalance 3-Psychological metrics.

Cont…. In a meta-analysis of 11 studies of

healthy individuals Depressive mood. (RR-1.7) Clinical depression.(RR-2.3) Whether therapy for post-infarction depression reduces recurrent event

rates remains controversial

Body weights BMI

Normal weight : 18.5–24.9 kg/m2 Overweight : 25–29 kg/m2; Obesity : >30.0 kg/m2 class I 30.0–34.9 class II 34.9–39.9, class III ≥40 kg/m2). Abdominal obesity is defined according waist circumference: men >102 cm (>40

in) &women >88 cm (35 in)

Clinical Importance of Global Estimates for CHD

Risk

Total (global) risk summation of all major risk factors can be clinically useful for 3 purposes: 1) Identification of high-risk patients who deserve immediate attention and intervention,

2) Motivation of patients to adhere to risk-reduction therapies.

3) Modification of intensity of risk-reduction efforts based on the total risk estimate.

Primary Versus Secondary Prevention

This presentation focuses mainly on risk assessment

for coronary disease and not on risk for cardiovascular outcomes. Framingham scores estimate risk for persons

without clinical manifestations of CHD Therefore, the scores apply only to primary prevention.

Once coronary atherosclerotic disease becomes clinically manifest, the risk for future coronary events is much higher than that for patients without CHD regardless of other risk factors, and in this case, Framingham scoring no longer applies.

Severity of Major Risk Factors

• The scoring does not adequately account for severe abnormalities of risk factors,e.g. severe hypertension, severe hypercholesterolemia, or heavy cigarette smoking. This underestimation is particularly evident when only 1 severe risk factor is present.

• Thus, heavy smoking or severe hypercholesterolemia

can lead to premature CHD even when the summed score for absolute risk is not high. Likewise, the many dangers of prolonged, uncontrolled hypertension are

well known.

Diabetes Mellitus as a Special Case in Risk Assessment

Both type 1 and type 2 diabetes confer a heightened risk for CVD. When the risk factors of diabetic patients are summed, their risk often approaches that of patients with established CHD. Considerations about the very high risk of patients with diabetes apply to ethnic groups that have a relatively high population risk for CHD. Inclusion of patients with type 2 diabetes in the very-high-risk category may not be appropriate when they belong to ethnic groups with a low population risk.

•

Definition of a Low-Risk State

Serum total cholesterol: 160 to 190 LDL-C :100 to 129 HDL-C: >45 in men and >55 in

women Blood pressure: <120 mm Hg systolic and <80 mm Hg diastolic Non Smoker No diabetes mellitus

IDEAL GOAL FOR INDIVIDUALS

Serum total cholesterol: 100 to 130 LDL-C :<80 HDL-C: > 80 Blood pressure: <115 mm Hg systolic and <75 mm Hg diastolic Non Smoker No diabetes mellitus