RISK FACTOR FOR CORONARY ARTERY DISEASE

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RISK FACTOR FOR CORONARY ARTERY DISEASE

• Dr.Animesh Mishra MD (BHU), DM (Delhi
  University).
• Associate Professor, Department of cardiology
• NEIGRIHMS,Shillong-12

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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.

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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.

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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.

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Major Independent Risk Factors AHA/ACC
Scientific Statement

• Cigarette smokingElevated blood
  pressureElevated serum total (and LDL)
  cholesterolLow serum HDL cholesterolDiabetes
  mellitusAdvancing age

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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.

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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)

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MENTAL STRESS,DEPRESSION,AND CARDIOVASCULAR RISK

• From Clinicians perspective-As a modifiable
  risk factor
• 1- Acute stress
• 2- Work related stress
• (a)-Job strain
• (b)-Effort-reward imbalance
• 3-Psychological metrics.

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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

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Body weights BMI

• Normal weight 18.524.9 kg/m2
• Overweight 2529 kg/m2
• Obesity gt30.0 kg/m2
• class I 30.034.9
• class II 34.939.9,
• class III 40 kg/m2).
• Abdominal obesity is defined according
• waist circumference men gt102 cm (gt40 in)
• women gt88 cm (35 in)

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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.

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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.

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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.

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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.

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Definition of a Low-Risk State

• Serum total cholesterol 160 to 190
• LDL-C 100 to 129
• HDL-C gt45 in men and gt55 in women
• Blood pressure lt120 mm Hg systolic
• and lt80 mm Hg diastolic
• Non Smoker
• No diabetes mellitus

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IDEAL GOAL FOR INDIVIDUALS

• Serum total cholesterol 100 to 130
• LDL-C lt80
• HDL-C gt 80
• Blood pressure lt115 mm Hg systolic
• and lt75 mm Hg diastolic
• Non Smoker
• No diabetes mellitus

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