Risk factors for coronary heart disease - Atherosclerosis is responsible for almost all cases of CHD. This insidious process begins with fatty streaks which are first seen in adolescence; these lesions progress into plaques in early adulthood, and culminate in thrombotic occlusions and coronary events in middle age and later life.
A variety of factors, often acting in concert, are associated with an increased risk for atherosclerotic plaques in coronary arteries and other arterial beds.
Risk factor assessment is useful in adults to guide therapy for dyslipidemia, hypertension, and diabetes. A 12 year follow-up of 14,786 Finnish men and women,
age 25 to 64, found that the incidence of CHD was threefold higher in men than women and mortality was fivefold higher.
Differences in serum total cholesterol, blood pressure, body mass index, and prevalence of diabetes accounted for about one-third of the age-related increase in CHD prevalence in men and 50 to 60 percent in women.
Cardiovascular risk factors promote coronary disease in either sex at all ages but with different strengths.
- Diabetes and a low high density lipoprotein (HDL) - cholesterol/total cholesterol ratio operate with greater power in women.
- Cigarette smoking has more of an impact in men, is noncumulative, and loses its adverse impact shortly after the cessation of smoking.
- Systolic blood pressure and isolated systolic hypertension are major risk factors at all ages in either sex.
- Some risk factors, such as dyslipidemia, impaired glucose tolerance, and fibrinogen have a diminished impact with advancing age but a lower relative risk is offset by a high absolute risk in the elderly. Thus, all of the major risk factors continue to be relevant in older persons.
- Obesity or weight gain promotes or aggravates all the atherogenic risk factors and physical inactivity worsens some of them, predisposing subjects of all ages to coronary events.