Coronary Artery Disease - Risk Factors

Risk Factors

The following are confirmed independent risk factors for the development of CAD:

1. Hypercholesterolemia (specifically, serum LDL concentrations)
2. Smoking
3. Hypertension (high systolic pressure seems to be most significant in this regard)
4. Hyperglycemia (due to diabetes mellitus or otherwise)
5. Type A Behavioural Patterns, TABP. Added in 1981 as an independent risk factor after a majority of research into the field discovered that TABP's were twice as likely to exhibit CAD as any other personality type.
6. Hemostatic Factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. Factor VII levels are higher in individuals with a high intake of dietary fat. Decreased fibrinolytic activity has been reported in patients with coronary atherosclerosis.
7. Hereditary differences/genetic polymorphisms in such diverse aspects as lipoprotein structure and that of their associated receptors, enzymes of lipoprotein metabolism such as cholesteryl ester transfer protein (CETP) and hepatic lipase (HL), homocysteine processing/metabolism, etc.
8. High levels of Lipoprotein(a), a compound formed when LDL cholesterol combines with a substance known as Apoliprotein (a).

Significant, but indirect risk factors include:

• Lack of exercise
• Consumption of alcohol
• Stress
• Diet rich in saturated fats
• Diet low in antioxidants
• Obesity
• Men over 60; Women over 65
• A recent study done in India (Pondicherry) shows its association with hemoglobin

Risk factors can be classified as

1. Fixed: age, sex, family history
2. Modifiable: smoking, hypertension, diabetes mellitus, obesity, etc.

There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on different variables above. A notable example is Framingham Score, used in the Framingham Heart Study. It is mainly based on age, gender, diabetes, total cholesterol, HDL cholesterol, tobacco smoking and systolic blood pressure.