Q. Find out risk factors for coronary disease?

1) Tobacco

Smoking, the single most preventable cause of death is a leading risk factor for CAD, cerebrovascular accident and PVD. Second hand smoke has been shown to increase risk of CAD. Exposure to second hand smoke increases by 30 per cent the risk of death by CAD.

2) Hypertension

Hypertension continues to be a major, independent risk factor for CAD. It contributes to MI, cerebrovacsular accidents, congestive heart failure (CHF), peripheral vascular disease (PVD), and increased mortality among men and women of all ages and ethnic groups with or without signs or symptoms of CAD.

Baseline blood pressure was shown to be strongly and independently related to increased risk of CAD. The relationship was shown to be stronger for systolic than diastolic blood pressure or pulse pressure, with the risk for CAD progressively increasing with an increase in systolic blood pressure.

Risk for cardiovascular disease among patients with hypertension is determined by the level of blood pressure and by the presence or absence of end-organ damage or other risk factors such as smoking, dyslipidemia, and diabetes. Antihypertensive treatment has proved beneficial in the prevention and reduction of the progression of hypertension, cerebrovascular accidents, CHF, renal insufficiency, and renal failure. (See section on hypertension)

3) Diabetes Mellitus

Insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) are powerful, independent predictors of CAD. CAD is the leading cause of premature death among patients with IDDM or NIDDM, and accounts for almost 80 per cent of all deaths and hospital admission among persons with diabetes.

At autopsy, most persons with diabetes are found to have a greater number of affected coronary vessels, more diffuse distribution of atherosclerosis and greater narrowing of the left main coronary artery than persons without diabetes.

Younger persons with IDDM are not spared. Severe and extensive luminal narrowing of large coronary arteries has been found in persons who had an onset of IDDM before 15 years of age and died before the age of 40 years. Persons with diabetes in the Framingham study were nearly four times more likely to have additional cardiovascular risk factors than persons without diabetes.

Diabetes is associated with metabolic abnormalities in the transport, composition, and metabolism of lipoproteins. These abnormalities are associated with the type of diabetes, glycemia control, obesity, insulin, resistance, presence of diabetic nephropathy, and genetic factors. The dyslipidemia associated with the diabetes includes hypertriglyceridemia, low levels of high density lipoprotein (HDL), alterations in the composition of LDL, and increase in apo B and apo E. Lipid lowering therapy is considered critical in the management of NIDDM.