Factors most strongly implicated in atherosclerosis are:
- male sex
- age
- smoking - two to three fold increase in risk
- hypertension - two to three fold increase in risk
- diabetes - two to three fold increase in risk
- syndrome X
- hypercholesterolaemia:
- there is probably no "safe" level, although 5 mmol/L is used as the cut-off
- family history of premature coronary heart disease
- male first degree relative's first CHD event occurred before the age of 55, or a female first degree relative's first CHD event occurred before 65
"Weaker" risk factors include:
- use of the combined oral contraceptive pill:
- the mini-pill does not increase the risk of heart disease
- excessive alcohol
- obesity
- geographical factors:
- low risk in Sweden and Japan
- high risk in Scotland
- socioeconomic class - lower social classes have a higher risk of development of heart disease in the UK
- psychological risk factors ("stress")
- there is strong evidence to support an association between depression, social isolation or lack of social support, and catastrophic life events and coronary heart disease
- premature menopause
- bilateral oophorectomy - removal of both ovaries at age of 35 without subsequent HRT produces a seven fold increase in risk
- low fibrinolytic activity - fibrinolytic activity is inversely related to smoking and obesity and positively related to exercise
Note
In the UK, the highest recorded rates of coronary artery disease mortality are in people born in India, Pakistan and Bangladesh (2). South Asians have a 40-60% higher risk of CHD-related mortality compared to other populations.
References:
- Risk estimation and the prevention of cardiovascular disease. Scottish Intercollegiate Guidelines Network - SIGN (2017)
- Ramaraj R, Chellappa P. Cardiovascular risk in South Asians. Postgrad Med J. 2008 Oct;84(996):518-23.