Coronary heart disease risk factors: Difference between revisions

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{{Coronary heart disease}}
{{Coronary heart disease}}
{{CMG}}
{{CMG}}
{{SK}} CAD risk factors; risk factors for CAD


==Overview==
==Overview==
There are many risk factors and risk equivalents associated with coronary heart disease. Risk factors include [[cigarette smoking]], [[hypertension]], a family history of premature coronary artery disease, high [[LDL]] cholesterol, low [[HDL]] cholesterol, and older age. Some of these risk factors are modifiable, and are good targets for primary prevention in the health care setting.
==Risk Factors==
===Proposed Risk Factor Categories based on the 27th Bethesda Conference<ref name="pmid8609364">Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8609364 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease.] ''J Am Coll Cardiol'' 27 (5):978-90. PMID: [http://pubmed.gov/8609364 8609364]</ref>===
{{cquote|
'''Category I:''' Risk factors for which interventions have '''proved''' to reduce the incidence of [[coronary artery disease]] events such as [[Chronic stable angina treatment smoking cessation|cigarette smoking]], [[Chronic stable angina treatment lipid management|LDL cholesterol]], dietary modification, [[Chronic stable angina treatment blood pressure control|hypertension]] and thrombogenic factors.
'''Category II:''' Risk factors for which interventions are '''likely''', based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of [[coronary artery disease]] events such as [[Chronic stable angina treatment diabetes control|diabetes]], [[Chronic stable angina treatment physical activity|physical inactivity]], [[Chronic stable angina treatment lipid management|HDL cholesterol]], [[Chronic stable angina treatment weight management|obesity]] and postmenopausal status.
'''Category III:''' Risk factors clearly associated with an increase in [[coronary artery disease]] risk and which, if modified, '''might lower''' the incidence of [[coronary artery disease]] events such as psychosocial factors, [[Chronic stable angina treatment lipid management|triglycerides]], Lp(a), [[homocysteine]], oxidative stress and alcohol consumption.
'''Category IV:''' Risk factors associated with increased risk but which cannot be modified or whose modification would be '''unlikely''' to change the incidence of [[coronary artery disease]] events such as age, gender, family history and many others.}}
==Risk Equivalents in Primary Prevention==
You are essentially considered to have the equivalent of coronary heart disease if you have any of the following:
*[[Aortic aneurysm]]
*[[Diabetes]]
*[[Framingham Risk Score]] ([[FRS]]) of > 20%
*[[Peripheral vascular disease]] ([[PVD]]) (defined as [[claudication]], an [[Ankle Brachial Index]] ([[ABI]]) of < 0.9)
*Symptomatic [[carotid artery disease]] (defined as prior [[stroke]] or [[TIA]])
==Cardiovascular Risk Factors in the Setting of Primary Prevention==
* [[Cigarette smoking]]
* Family history of premature [[coronary artery disease]] ([[CAD]])
* High [[LDL]] (defined as LDL > 130 mg /dl)
* [[Hypertension]] ( defined as a BP ≥140/90 mm Hg or if the patient is on antihypertensive drugs)
* Low [[HDL]] (defined as HDL < 40 mg/dL males, < 50 mg/dL in females)
* Older Age (men ≥45 years old; women ≥55 years old)


==Risk factors==
==European Systematic Coronary Risk Evaluation (SCORE) system <ref name="pmid12788299">Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12788299 Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.] ''Eur Heart J'' 24 (11):987-1003. PMID: [http://pubmed.gov/12788299 12788299]</ref>==
'''The following are confirmed independent risk factors for the development of CAD, in order of decreasing importance:'''
# [[Hypercholesterolemia]] (specifically, serum [[LDL]] concentrations)
# [[tobacco smoking|Smoking]]
# [[Hypertension]] (high systolic pressure seems to be most significant in this regard)
# [[Hyperglycemia]] (due to diabetes mellitus or otherwise)
# [[Type A personality |Type A Behavioural Patterns, TABP]]. Added in 1981 as an independant risk factor after a majority of research into the field discovered that TABP's were twice as likely to cause CHD than any other personality type.
# Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism, etc.


'''Significant, but indirect risk factors include:'''
* The '''SCORE''' project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.
* Lack of exercise
* This system includes both non-modifiable and modifiable coronary risk factors such as:
* Stress
:*Age
* Diet rich in [[saturated fat]]s
:*Gender
* Diet low in [[antioxidant]]s
:*[[Chronic stable angina treatment blood pressure control|Systolic blood pressure]]
* [[Obesity]]
:*[[Chronic stable angina treatment smoking cessation|Smoking]]
* Men over 60; Women over 65 [http://findarticles.com/p/articles/mi_m0857/is_n6_v13/ai_17942856]
:*[[Chronic stable angina treatment lipid management|Total cholesterol and/or cholesterol:HDL ratio]]
:to estimate a person’s total ten-year risk of cardiovascular death.
* Patients with established [[coronary artery disease]], [[diabetics]] with [[microalbuminuria]], asymptomatic patients with multiple risk factors are considered high-risk for the development of fatal coronary event.
:* The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.


== Cardiac Risk Factors ==
== Complete List of Cardiac Risk Factors ==


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
In alphabetical order: <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


* ACE DD genotype
* [[ACE]] DD genotype
* Age
* Age
*:* Men > 45
*:* Men > 45
*:* Women > 45 (early [[menopause]])
*:* Women > 45 (early [[menopause]])
*:* Women > 55 (normal onset [[menopause]])
*:* Women > 55 (normal onset [[menopause]])
* [[Alcohol]]
* [[Chronic obstructive lung disease]] ([[COPD]])
* [[Chronic Renal Failure]]
* [[Chronic Renal Failure]]
* [[Cigarette smoking]]
* [[Cigarette smoking]]
Line 39: Line 64:
* [[Diabetes Mellitus]]
* [[Diabetes Mellitus]]
* [[Family history]] of premature [[coronary artery disease]]
* [[Family history]] of premature [[coronary artery disease]]
* [[HDL cholesterol]] > 130 mg/dl
* [[HDL cholesterol]] < 40 mg/dl
* [[Hyperhomocysteinemia]]
* [[Hyperhomocysteinemia]]
* [[Hypertension]]
* [[Hypertension]]
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* [[Immunosuppressive posttransplant]]
* [[Immunosuppressive posttransplant]]
* Increased [[apolipoprotein B]]
* Increased [[apolipoprotein B]]
* Increased [[Ddx:C-Reactive Protein|C-reactive protein]]
* Increased [[C-reactive protein]]
* Increased [[Ddx:Fibrinogen|fibrinogen]]
* Increased [[Fibrinogen|fibrinogen]]
* [[Infection]]s
* [[Infection]]s
* [[Insulin resistance]] syndrome
* [[Insulin resistance]] syndrome
* Lack of supportive primary relationship
* Lack of supportive primary relationship
* [[LDL cholesterol]] < 40 mg/dl
* [[LDL cholesterol]] > 130 mg/dl  
* [[Low birth weight]]
* [[Low birth weight]]
* [[Metabolic syndrome]]
* [[Obesity]]
* [[Obesity]]
* [[Oral contraceptive]] use
* [[Oral contraceptive]] use
* [[Sedentary living]]
* [[Sedentary living]]
* [[Syndrome X]]
* [[Syndrome X]]
* <u>Type A personality</u>
* Type A personality
 
==ACC/AHA Guidelines- Pocket Guideline: 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults (DO NOT EDIT)==
{{cquote|
===Risk Stratification and Genomics===
*Global Risk Scoring Recommendation
Class I 1. Global risk scores (such as the Framingham Risk Score) that use multiple traditional cardiovascular risk factors should be obtained for risk assessment in all asymptomatic adults without a clinical history of CHD. These scores are useful for combining individual risk factor measurements into a single quantitative estimate of risk that can be used to targe preventive interventions. (Level of Evidence: B)
 
*Family History Recommendation
Class I 1. Family history of atherothrombotic CVD should be obtained for cardiovascular risk assessment in all asymptomatic adults. (Level of Evidence: B)
 
*Genotypes Recommendation
Class III: 1. Genotype testing for CHD risk assessment in No Benefit asymptomatic adults is not recommended. (Level of Evidence: B)
 
 
===Lipoproteins and Circulating Blood Markers===
*Lipoprotein and Apolipoprotein Assessments Recommendation
Class III: 1. Measurement of lipid parameters, including No Benefit lipoproteins, apolipoproteins, particle size, and density, beyond standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults. (Level of Evidence: C)
 
*Natriuretic Peptides Recommendation
Class III: 1. Measurement of natriuretic peptides is not No Benefit recommended for CHD risk assessment in asymptomatic adults. (Level of Evidence: B)
 
*C-Reactive Protein Recommendations
Class IIa 1. In men 50 years of age or older or women 60 years of age or older with low-density lipoprotein cholesterol less than 130 mg/dL; not on lipid-lowering, hormone replacement, or immunosuppressant therapy; without clinical CHD, diabetes, chronic kidney disease, severe inflammatory conditions or contraindications to statins, measurement of CRP can be useful in the selection of patients for statin therapy. (Level of Evidence: B)
Class IIb 1. In asymptomatic intermediate-risk men 50 years of age or younger or women 60 years of age or younger, measurement of CRP may be reasonable for cardiovascular risk assessment. (Level of Evidence: B)
Class III: 1. In asymptomatic high-risk adults, measurement of No Benefit CRP is not recommended for cardiovascular risk assessment. (Level of Evidence: B)
2. In low-risk men younger than 50 years of age or women 60 years of age or younger, measurement of CRP is not recommended for cardiovascular risk assessment. (Level of Evidence: B)
 
*Hemoglobin A1C Recommendation
Class IIb 1. Measurement of hemoglobin A1C may be reasonable for cardiovascular risk assessment in asymptomatic adults without a diagnosis of diabetes. (Level of Evidence: B)
 
*Lipoprotein-Associated Phospholipase A2 Recommendation
Class IIb 1. Lipoprotein-associated phospholipase A2 might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults. (Level of Evidence: B)
 
*Microalbuminuria Recommendations
Class IIa 1. In asymptomatic adults with hypertension or diabetes, urinalysis to detect microalbuminuria is reasonable for cardiovascular risk assessment. (Level of Evidence: B)
Class IIb 1. In asymptomatic adults at intermediate risk without hypertension or diabetes, urinalysis to detect microalbuminuria might be reasonable for cardiovascular risk assessment. (Level of Evidence: B)
 
===Cardiac and Vascular Tests===
*Resting Electrocardiogram Recommendations
Class IIa 1. A resting electrocardiogram (ECG) is reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes. (Level of Evidence: C)
Class IIb 1. A resting ECG may be considered for cardiovascular risk assessment in asymptomatic adults without hypertension or diabetes. (Level of Evidence: C)
 
*Transthoracic Echocardiography Recommendations
Class IIb 1. Echocardiography to detect left ventricular hypertrophy may be considered for cardiovascular risk assessment in asymptomatic adults with hypertension. (Level of Evidence: B)
Class III: 1. Echocardiography is not recommended for No Benefit cardiovascular risk assessment of CHD in asymptomatic adults without hypertension. (Level of Evidence: C)
 
*Carotid Intima-Media Thickness Recommendation
Class IIa 1. Measurement of carotid artery intima-media thickness is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk. Published recommendations on required equipment, technical approach, and operator training and experience for performance of the test must be carefully followed to achieve high-quality results. (Level of Evidence: B)
 
*Brachial/Peripheral Flow-Mediated Dilation
Recommendation
Class III: 1. Peripheral arterial flow-mediated dilation studies No Benefit are not recommended for cardiovascular risk assessment in asymptomatic adults. (Level of Evidence: B)
 
*Specific Measures of Arterial Stiffness Recommendation
Class III: 1. Measures of arterial stiffness outside of research No Benefit settings are not recommended for cardiovascular risk assessment in asymptomatic adults. (Level of Evidence: C)
 
*Ankle-Brachial Index Recommendation
Class IIa 1. Measurement of ankle-brachial index is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk. (Level of Evidence: B)
 
*Exercise Electrocardiography Recommendation
Class IIb 1. An exercise ECG may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), particularly when attention is paid to non-ECG markers such as exercise capacity. (Level of Evidence: B)
 
*Stress Echocardiography Recommendation
Class III: 1. Stress echocardiography is not indicated for No Benefit cardiovascular risk assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacological stress echocardiography is primarily used for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known CAD or the assessment of patients with known or suspected valvular heart disease.) (Level of Evidence: C)
 
*Myocardial Perfusion Imaging Recommendations
Class IIb 1. Stress myocardial perfusion imaging (MPI) may be considered for advanced cardiovascular risk assessment in asymptomatic adults with diabetes or asymptomatic adults with a strong family history of CHD or when previous risk assessment testing suggests a high risk of CHD, such as a coronary artery calcium (CAC) score of 400 or greater. (Levelof Evidence: C)
Class III: 1. Stress MPI is not indicated for cardiovascular risk No Benefit assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacologic stress MPI is a technology primarily used and studied for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known coronary artery disease.) (Level of Evidence: C)
 
*Calcium Scoring Methods Recommendations
Class IIa 1. Measurement of CAC is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10% to 20% 10-year risk). (Level of Evidence: B)
Class IIb 1. Measurement of CAC may be reasonable for cardiovascular risk assessment persons at low to intermediate risk (6% to 10% 10-year risk). (Level of Evidence: B)
Class III: 1. Persons at low risk (<6% 10-year risk) should not No Benefit undergo CAC measurement for cardiovascular risk assessment. (Level of Evidence: B)
 
*Coronary Computed Tomography Angiography
Recommendation
Class III: 1. Coronary computed tomography angiography is No Benefit not recommended for cardiovascular risk assessment in asymptomatic adults. (Level of Evidence: C)
 
*Magnetic Resonance Imaging of Plaque Recommendation
Class III: 1. Magnetic resonance imaging for detection of No Benefit vascular plaque is not recommended for cardiovascular risk assessment in asymptomatic adults. (Level of Evidence: C)
 
===Additional Considerations===
*Patients With Diabetes Recommendations
Class IIa 1. In asymptomatic adults with diabetes, 40 years of age and older, measurement of CAC is reasonable for cardiovascular risk assessment. (Level of Evidence: B)
Class IIb 1. Measurement of hemoglobin A1C may be considered for cardiovascular risk assessment in asymptomatic adults with diabetes. (Level of Evidence: B)
2. Stress MPI may be considered for advanced cardiovascular risk assessment in asymptomatic adults with diabetes or when previous risk assessment testing suggests a high risk of CHD, such as a CAC score of 400 or greater. (Level of Evidence: C)


*Women Recommendations
==2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888  }} </ref>==
Class I 1. A global risk score should be obtained in all asymptomatic women. (Level of Evidence: B)
===Identification of Patients at Risk (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888  }} </ref>===
2. Family history of CVD should be obtained for cardiovascular risk assessment in all asymptomatic women. (Level of Evidence: B)
{|class="wikitable"
}}
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Primary care providers should evaluate the presence and status of control of major risk factors for [[CHD]] for all patients at regular intervals (approximately every 3 to 5 years). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic [[CHD]] should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies.<ref name="pmid15249516">{{cite journal| author=Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB et al.| title=Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. | journal=Circulation | year= 2004 | volume= 110 | issue= 2 | pages= 227-39 | pmid=15249516 | doi=10.1161/01.CIR.0000133317.49796.0E | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15249516  }} </ref><ref name="pmid12485966">{{cite journal| author=National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)| title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. | journal=Circulation | year= 2002 | volume= 106 | issue= 25 | pages= 3143-421 | pmid=12485966 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12485966  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with established [[CHD]] should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., [[atherosclerosis]] in other [[vascular bed]]s, [[diabetes mellitus]], [[chronic kidney disease]], or 10-year risk greater than 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Cardiology]]

Latest revision as of 17:44, 27 February 2019

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Risk calculators and risk factors for Coronary heart disease risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: CAD risk factors; risk factors for CAD

Overview

There are many risk factors and risk equivalents associated with coronary heart disease. Risk factors include cigarette smoking, hypertension, a family history of premature coronary artery disease, high LDL cholesterol, low HDL cholesterol, and older age. Some of these risk factors are modifiable, and are good targets for primary prevention in the health care setting.

Risk Factors

Proposed Risk Factor Categories based on the 27th Bethesda Conference[1]

“

Category I: Risk factors for which interventions have proved to reduce the incidence of coronary artery disease events such as cigarette smoking, LDL cholesterol, dietary modification, hypertension and thrombogenic factors.

Category II: Risk factors for which interventions are likely, based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of coronary artery disease events such as diabetes, physical inactivity, HDL cholesterol, obesity and postmenopausal status.

Category III: Risk factors clearly associated with an increase in coronary artery disease risk and which, if modified, might lower the incidence of coronary artery disease events such as psychosocial factors, triglycerides, Lp(a), homocysteine, oxidative stress and alcohol consumption.

Category IV: Risk factors associated with increased risk but which cannot be modified or whose modification would be unlikely to change the incidence of coronary artery disease events such as age, gender, family history and many others.

”

Risk Equivalents in Primary Prevention

You are essentially considered to have the equivalent of coronary heart disease if you have any of the following:


Cardiovascular Risk Factors in the Setting of Primary Prevention

  • Cigarette smoking
  • Family history of premature coronary artery disease (CAD)
  • High LDL (defined as LDL > 130 mg /dl)
  • Hypertension ( defined as a BP ≥140/90 mm Hg or if the patient is on antihypertensive drugs)
  • Low HDL (defined as HDL < 40 mg/dL males, < 50 mg/dL in females)
  • Older Age (men ≥45 years old; women ≥55 years old)

European Systematic Coronary Risk Evaluation (SCORE) system [2]

  • The SCORE project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.
  • This system includes both non-modifiable and modifiable coronary risk factors such as:
to estimate a person’s total ten-year risk of cardiovascular death.
  • The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.

Complete List of Cardiac Risk Factors

In alphabetical order: [3] [4]

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)[5]

Identification of Patients at Risk (DO NOT EDIT)[5]

Class I
"1. Primary care providers should evaluate the presence and status of control of major risk factors for CHD for all patients at regular intervals (approximately every 3 to 5 years). (Level of Evidence: C)"
"2. Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic CHD should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies.[6][7] (Level of Evidence: B)"
"3. Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, diabetes mellitus, chronic kidney disease, or 10-year risk greater than 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. (Level of Evidence: A)"

References

  1. ↑ Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 27 (5):978-90. PMID: 8609364
  2. ↑ Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24 (11):987-1003. PMID: 12788299
  3. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  5. ↑ 5.0 5.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE; et al. (2011). "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 123 (18): e426–579. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888.
  6. ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB; et al. (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines". Circulation. 110 (2): 227–39. doi:10.1161/01.CIR.0000133317.49796.0E. PMID 15249516.
  7. ↑ National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002). "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. PMID 12485966.
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