Risk Factors for Coronary Artery Disease Updated: Nov 27, 2016 Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine Subhi Ali, MD, FACC, FACP, MSCI more...
Practice Essentials Risk factors for coronary artery disease (CAD) were not formally established until the initial findings of the Framingham Heart Study in the early 1960s. The understanding of such factors is critical to the prevention of cardiovascular morbidities and mortality. See the image below.
Traditional versus nontraditional risk factors for coronary artery disease (CAD). The expanding list of nontraditional biomarkers is outweighed by the standard risk factors for predicting future cardiovascular events and adds only moderately to standard risk factors. BNP = B-type natriuretic peptide; BP = blood pressure; CRP = C-reactive protein; HDL = high-density lipoprotein cholesterol; HIV = human immunodeficiency virus infection.
Risk factors for coronary artery disease Conventional risk factors Older age: Over age 45 years in men and over age 55 years in women Family history of early heart disease Race: Among persons with CAD, the cardiovascular death rate for African Americans is reported to be particularly high; in Asians, low levels of high-density lipoprotein cholesterol (HDLC), which are considered to be a risk factor for coronary heart disease, appear to be especially prevalent; South Asians appear to have a higher independent risk for cardiovascular disease as well. Modifiable risk factors High blood cholesterol levels (specifically, low-density lipoprotein cholesterol [LDL-C]) High blood pressure Cigarette smoking: Cessation of cigarette smoking constitutes the single most important preventive measure for CAD Diabetes mellitus  Obesity Lack of physical activity Metabolic syndrome Mental stress and depression Nontraditional or novel risk factors High levels of the following are considered to be risk factors for CAD: C-reactive protein (CRP): High levels are related to the presence of inflammation and, according to some research results, may be associated with an increased risk of CAD development and heart attack  Lipoprotein(a) Homocysteine: In the general population, mild to moderate elevations are due to insufficient dietary intake of folic acid, but homocysteine levels may also identify people at increased risk for heart disease Small, dense LDL-C particles Fibrinogen Various medical conditions that can contribute to CAD include the following: End-stage renal disease (ESRD) Chronic inflammatory diseases affecting connective tissues (eg, lupus, rheumatoid arthritis) [3, 4] Human immunodeficiency virus (HIV) infection (acquired immunodeficiency syndrome [AIDS], highly active antiretroviral therapy [HAART])  Xanthelasmata (raised yellow patches around the eyelids) The following are also considered to be risk factors: Tissue plasminogen activator (tPA): An imbalance of the clot dissolving enzymes (eg, tPA) and their respective inhibitors (plasminogen activator inhibitor-1 [PAI-1]) may predispose individuals to myocardial infarctions Low serum testosterone levels: Have a significant negative impact on patients with CAD Hysterectomy: A study suggests that this becomes a risk factor later in life in women who have the surgery at or before age 50 years Lack of sleep
Identifying coronary artery disease Direct plaque imaging Electron-beam computed tomography (EBCT) scanning: To identify coronary calcification; can reveal at-risk individuals and perhaps allow for medical monitoring  64-slice CT angiography: Bulky plaques may be identified in asymptomatic patients; the risk-benefit of using CT angiography in an asymptomatic patient for the identification of atherosclerotic plaques is still a subject of much debate Carotid intima-media thickness (IMT), pulse wave velocity (PWV), and the ankle-brachial index (ABI): Widely used, noninvasive modalities for evaluating atherosclerosis Biomarkers In a 10-year comparison of 10 biomarkers for predicting death and major cardiovascular events in approximately 3000 individuals, the most informative biomarkers for predicting death were as follows: B-type natriuretic peptide (BNP) CRP Homocysteine Renin Urinary albumin-to-creatinine ratio The most informative biomarkers for predicting major cardiovascular events were BNP and the urinary albumin-to-creatinine ratio.