Risk factors

Factors most strongly implicated in atherosclerosis are:

• male sex
• age
• smoking - two to three fold increase in risk
• hypertension - two to three fold increase in risk
• diabetes - two to three fold increase in risk
• syndrome X
• hypercholesterolaemia:
  • there is probably no "safe" level, although 5 mmol/L is used as the cut-off
• family history of premature coronary heart disease
  • male first degree relative's first CHD event occurred before the age of 55, or a female first degree relative's first CHD event occurred before 65

"Weaker" risk factors include:

• use of the combined oral contraceptive pill:
  • the mini-pill does not increase the risk of heart disease
• excessive alcohol
• obesity
• geographical factors:
  • low risk in Sweden and Japan
  • high risk in Scotland
• socioeconomic class - lower social classes have a higher risk of development of heart disease in the UK
• psychological risk factors ("stress")
  • there is strong evidence to support an association between depression, social isolation or lack of social support, and catastrophic life events and coronary heart disease (1)
• premature menopause
• bilateral oophorectomy - removal of both ovaries at age of 35 without subsequent HRT produces a seven fold increase in risk
• low fibrinolytic activity - fibrinolytic activity is inversely related to smoking and obesity and positively related to exercise

Reference:

1. Bunker SJ et al. Stress and coronary heart disease: psychosocial risk factors. Med J Aust 2003;178:272-6.