Transcript RISK FACTOR FOR CORONARY ARTERY DISEASE

RISK FACTOR FOR CORONARY
ARTERY DISEASE
Dr.Animesh Mishra; MD (BHU), DM (Delhi University).
Associate Professor, Department of cardiology
NEIGRIHMS,Shillong-12
PURPOSE OF THIS
VEDIO-CONFERENCING
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Dissemination of information relative to the prevention
of atherosclerosis and its adverse consequences.
Development of educational pro-grams specific to the
role of the cardiovascular specialist with regard to
prevention.
Cooperative development of practice guidelines, for
consultative as well as rehabilitation services, to
deliver cost-effective preventive care.
Policies of fair reim-bursement for effective services.
Participation in the assessment of clinical outcomes of
such programs.
Cont....
To promote preventive cardiac care by
 Endorsing anti-smoking policies & programs.
 Encouraging healthy dietary behavior.
 Promoting prudent physical activity.
 Ensuring adequate control of blood pressure.
 Managing patients with hyperlipidemia,
metabolic, coagulative and other risk factors.
 Advising primary care physicians with regard
to risk reduction.
 Developing a cardiovascular health promotion
plan for cardiac patients and their families.
Definition of CHD
 Framingham definition:
Angina pectoris,
recognized and unrecognized MI,USA,& CHD
deaths.
 Recent Framingham report :“Hard" CHD
excludes angina pectoris.)
 (AFCAPS/Tex CAPS): Specified acute
coronary events as USA, AMI & coronary
death.
Major Independent Risk Factors
AHA/ACC Scientific Statement:
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
*These risk factors are defined as major risk
factors by the AHA .
Cont….
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)
MENTAL
STRESS,DEPRESSION,AND
CARDIOVASCULAR RISK
From Clinician’s perspective-As a
modifiable risk factor
1- Acute stress
2- Work related stress
(a)-Job strain
(b)-Effort-reward imbalance
3-Psychological metrics.
Cont….
In a meta-analysis of 11 studies of healthy
individuals
 Depressive mood. (RR-1.7)
 Clinical depression.(RR-2.3)
 Whether therapy for post-infarction
depression reduces recurrent event rates
remains controversial
Body weights
BMI
Normal weight : 18.5–24.9 kg/m2
Overweight :
25–29 kg/m2;
Obesity :
>30.0 kg/m2
class I 30.0–34.9
class II 34.9–39.9,
class III ≥40 kg/m2).
 Abdominal obesity is defined according
waist circumference: men >102 cm (>40 in)
&women >88 cm (35 in)
Clinical Importance of Global
Estimates for CHD Risk
Total (global) risk summation of all major
risk factors can be clinically useful for
3 purposes:
1) Identification of high-risk patients who deserve
immediate attention and intervention,
2) Motivation of patients to adhere to risk-reduction
therapies.
3) Modification of intensity of risk-reduction efforts
based on the total risk estimate.
Primary Versus
Secondary Prevention
This presentation focuses mainly on risk assessment
for coronary disease and not on risk for
cardiovascular outcomes.
Framingham scores estimate risk for persons without
clinical manifestations of CHD Therefore, the scores
apply only to primary prevention.
Once coronary atherosclerotic disease becomes
clinically manifest, the risk for future coronary
events is much higher than that for patients without
CHD regardless of other risk factors, and in this
case, Framingham scoring no longer applies.
Severity of Major Risk Factors
• The scoring does not adequately account for severe
abnormalities of risk factors,e.g. severe hypertension,
severe hypercholesterolemia, or heavy cigarette
smoking. This underestimation is particularly evident
when only 1 severe risk factor is present.
• Thus, heavy smoking or severe hypercholesterolemia
can lead to premature CHD even when the summed
score for absolute risk is not high. Likewise, the many
dangers of prolonged, uncontrolled hypertension are
well known.
Diabetes Mellitus as a Special Case
in Risk Assessment
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Both type 1 and type 2 diabetes confer a
heightened risk for CVD.
When the risk factors of diabetic patients are summed, their
risk often approaches that of patients with established CHD.
Considerations about the very high risk of patients with
diabetes apply to ethnic groups that have a relatively high
population risk for CHD.
Inclusion of patients with type 2 diabetes in the very-high-risk
category may not be appropriate when they belong to ethnic
groups with a low population risk.
Definition of a Low-Risk
State
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Serum total cholesterol: 160 to 190
LDL-C :100 to 129
HDL-C: >45 in men and >55 in women
Blood pressure: <120 mm Hg systolic
and <80 mm Hg diastolic
Non Smoker
No diabetes mellitus
IDEAL GOAL FOR
INDIVIDUALS
 Serum total cholesterol: 100 to 130
 LDL-C :<80
 HDL-C: > 80
 Blood pressure: <115 mm Hg systolic
and <75 mm Hg diastolic
 Non Smoker
 No diabetes mellitus