Cardiac Risk Factor

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Laboratory 4 Diagnostic-procedures 5 Radiology 6 Management 7 Notes 8 More General Terms 9 Additional Terms 10 References

More Specific Terms

• risk factors for coronary artery disease in patients with diabetes mellitus type-2

Etiology

• Risk factors:

• male age >= 45 years

• polymorphism ( haplotype I) on the Y chromosome affecting differential expression of genes related to inflammation & immunity, increases risk 50% independent of other risk factors [59]

• female age >= 55 years
• hormonal deficiency

• estrogen ( estradiol) deficiency (men & women) [19]
• androgen deprivation therapy

• elevated LDL cholesterol (> 160 mg/dL)
• low HDL cholesterol (< 40 mg/dL), even with low LDL [22]

• HDL cholesterol > 60 mg/dL allegedly compensates for one other cardiac risk factor [1]

• smoking [4a]; risk 25% greater in women than men [55]
• hypertension

• BP > 140/90, prehypertension [12] or being treated for hypertension [1]
• systolic hypertension during sleep [26]

• systolic blood pressure greater during sleep than when awake substantially increases risk associated with sleep deprivation [26]

• elevated resting heart rate (either sex)
• elevated plasma homocysteine*
• elevated insulin
• diabetes mellitus (2-fold risk)

• dysglycemia or increased HgbA1c inconsistent risk factor [5]
• glycated hemoglobin better than fasting glucose for predicting cardiovascular risk in non- diabetic adults [40]
• microalbuminuria [1]

• severe hypoglycemia is a risk factor [46]
• obesity: increased BMI, waist circumference or waist-to-hip ratio equally predictive of risk [53]
• metabolic syndrome (risk similar to diabetes alone) [43]
• obstructive sleep apnea

• adequate CPAP may reduce risk [61]

• non- coronary atherosclerosis [4]
• chronic kidney disease, even early stages [45]
• osteoporosis
• sibling history of cardiovascular disease [11]
• rheumatoid arthritis [13]
• lower level of education [15]
• sleep deprivation & and altered circadian sleep rhythms may play role [25,26,37]
• depression [47]
• HIV1 infection [31,33]
• elevated plasma C-reactive protein [31]
• radiation therapy [1]
• pharmaceutical agents:

• rofecoxib ( Vioxx), doclofenac [17,42]

• abnormal electrocardiogram in the elderly [64]
  

• * only marker that predicts cardiovascular mortality in the very old [28]
  
• Postulated risk factors for CAD:

• Chlamydia pneumonia infection

• no role for antibiotic treatment in CAD [9] see CLARICOR trial

• immune complexes (i.e. lupus erythematosus)
• stress, anger, hostility ( catecholamine release)
• poor oral hygiene

• brushing teeth < twice a day) [41]
• association with periodontal disease, not causality [48]
• transient increase in risk (4 weeks) after invasive dental procedure [48]

• low plasma antioxidants
• physical inactivity
• mediastinal irradiation
• elevated triglycerides
• dietary saturated fat [38]
• small, dense LDL particles
• increased Lp<a>
• increased VLDL remnants
• increased IDL
• xanthelasma
• leukocytosis
• thrombocytosis & increased platelet activity
• increased fibrinogen
• increased factor VIIa
• chronic inflammation [2]

• WBC > 6700/ mm3 in postmenopausal women (HR = 1.4-2.4) [8]

• family history of premature cardiovascular disease [3,63]
• increased serum N-terminal proBNP (HR=1.82, risk=24%)* [6]
• increased serum CRP (HR=1.46, risk=7.8%)*
• increased urinary albumin/creatinine (HR=1.88, risk=20%)*
• shorter telomere length in peripheral blood mononuclear cells [20]
• glucocorticoid receptor haplotype 3 [23]
• SNP profile may contribute to differences in lipid profiles & perhaps cardiac risk [24]
• increased weight gain relative to height during an infant's first 3 months of life [32]
• thigh circumference [35]
• living within 328 feet of a freeway [39]
• recurrent miscarriages or a stillbirth [49]
• binge drinking [50]
• screen entertainment time ( television &/or computer screen)

• risk independent of physical activity [52]

• diet soda [56]
• Na+ & K+ consumption/ secretion:

• low Na+/K+ consumption may diminish risk [57]

• delivery of small for gestational age infant [65]
  

• * hazzard ratio (HR) & absolute risk increase for highest 20% of elderly population ( cardiovascular event & mortality)
  
• NOT risk factors:

• not NSAIDs

• excluding rofecoxib ( Vioxx), doclofenac [17,42]

• not serum DHEA, serum testosterone [19]
• not most putative genetic risk factors [21]
• not fried foods ( olive oil or sunflower oil) [60]

Laboratory

• fasting lipid panel
• high-sensitivity serum C-reactive protein

• recommended in men >= 50 or women >= 60 to determine if they might benefit from statin therapy for primary prevention [51]
• might be reasonable in men < 50 & women < 60 if intermediate risk; not recommended for low or high risk patients

• in patients at intermediate risk, no benefit of

• genetic testing
• advanced lipid testing
• serum natriuretic peptide [51]

• renal function tests

• diminished glomerular filtration rate & microalbuminuria/ albuminuria are risk factors for cardiovascular disease
• add little to traditional cardiovascular risk factors for stratifying cardiovascular risk but do improve risk stratification for renal outcomes [54]

• serum NT-proBNP only laboratory test that improved prediction of coronary artery disease with Framingham risk score (HR > 2 for 10 year risk) HR=2.5 [66]

Diagnostic-procedures

• ankle-brachial index ABI < 0.7 & declining serial ABI may predict adverse cardiovascular outcomes, but USPSTF does not recommend [27]
• in patients at intermediate risk, no benefit of

• stress echocardiography [51]

• carotid ultrasound

• measurement of carotid- intima-media thickness (CMIT) reasonable if site (of testing) proficient [51]

Radiology

• in patients at intermediate risk, no benefit of

• coronary computed tomography angiography
• magnetic resonance imaging for the detection of vulnerable plaques [51]

• carotid artery calcium

• intermediate risk patients [51]
• patients >= 40 with diabetes mellitus
• serial testing not advised
• only imaging test that improved prediction of coronary artery disease with Framingham risk score (HR > 2 for 10 year risk) HR=6.2 [66]

Management

• (of risk)
• obtain Framingham risk score (or equivalent) on all asymptomatic adults [51]
• aspirin 81-162 mg QD or clopidogrel 75 mg QD*
• omega-3 fatty acids ( DHA, EPA)
• statins#
• omega-3 fatty acids & statins favorably affect risk profiles & diminish overall mortality [7]
• treatment induced lowering of LDL-cholesterol lowers cardiovascular risk, whereas treatment induced increase of HDL-cholesterol does not [30]
• Mediterranean diet may be better than low-fat diet [18]
• moderate consumption of alcohol reduces risk of coronary artery disease in men
• diet & lifestyle modifications are the cornerstone of management [34]

• * but not in combination see MATCH study & CHARISMA trial
• # may not be of benefit in the elderly (> 80) [14]

Notes

• Other Factors

• Fitness & Overweight: improvements in one measure somewhat, but not completely, offset deteriorations in the other

More General Terms

• cardiology
• health risk factor(s)

Additional Terms

• cardiac risk assessment
• cardiac risk index (CRI)
• cardiovascular disease (CVD)
• cardiovascular risk calculator
• cerebrovascular disease/disorder
• coronary artery disease (CAD)
• Framingham Risk Score
• risk factors associated with ischemic stroke

References

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cardiovascular risk factor