Cardiovascular Risk Factors

Objectives

After completion of this module the student should be able to:

1. List major independent risk factors and other risk factors for the development of cardiovascular disease
2. Calculate cardiovascular risk using the American Heart Associationís Multiple-Risk-Factor Assessment Equations
3. Identify modifiable risk factors
4. Locate information useful in devising a risk modifying strategy


Introduction

Risk factors for the development of cardiovascular disease may be categorized either by relative significance or modifiability.  Current guidelines jointly accepted by the American Heart Association and the American College of Cardiology are divided into the groups listed immediately below.
 

Major Independent Risk Factors:
Cigarette smoking
Elevated blood pressure
Elevated serum total (and LDL) cholesterol
Low serum HDL cholesterol
Diabetes mellitus
Advancing age


Other Risk Factors:

Predisposing risk factors
Obesity
Abdominal obesity
Physical inactivity
Family history of premature coronary heart disease
Ethnic characteristics
Psychosocial factors
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)


 
Of these listed risk factors, all but advancing age, family history and ethnicity may be modified using various interventions and treatments.  One unlisted factor, male gender, which affects risk assessment is also generally not considered as modifiable.

The complete text describing each factor in detail is available at the following link:

GRUNDY ET AL. Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59

Evaluation


Risk assessment is achieved by tabulation of points assigned to each of the major risk factors as defined by:

Global Risk Assessment Scoring

Then plotting the total points against aged on the charts linked below and based on gender:

Relative and Absolute Risk Estimates for CHD in Men

Relative and Absolute Risk Estimates for CHD in Women
 

Intervention

Risk reduction involves intervention in each area in which risk is identified.  Appropriate guidelines for treatment may be found at the following links:

Smoking Cessation

Treatment of hypertension

Treatment of lipid disorders
 
Management of diabetes

Weight reduction

Exercise Prescription



R. Roberts, MD
Updated 8/30/05


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