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Prevalence of conventional risk factors in patients with coronary heart disease
Umesh N Khot1, Monica B Khot, Christopher T Bajzer
1Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. khot@cvresearch.net
Insights
Most coronary heart disease (CHD) patients have conventional risk factors like smoking, diabetes, high blood pressure, and high cholesterol. Public health efforts should prioritize these factors to combat CHD.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Conventional wisdom suggests over 50% of coronary heart disease (CHD) patients lack traditional risk factors (smoking, diabetes, hyperlipidemia, hypertension).
- This perception fuels interest in non-traditional risk factors and genetic predispositions for CHD.
- This study challenges that notion by examining the prevalence of conventional risk factors in a large CHD patient cohort.
Purpose of the Study:
- To determine the actual prevalence of the four conventional risk factors among patients diagnosed with coronary heart disease (CHD).
Main Methods:
- Analysis of data from 122,458 patients across 14 international randomized clinical trials of CHD conducted over a decade (2002-2003).
- Included patients with ST-elevation myocardial infarction, unstable angina/non-ST-elevation myocardial infarction, and those undergoing percutaneous coronary intervention.
- Assessed the prevalence of each conventional risk factor and the number of factors present, comparing across sex and age groups.
Main Results:
- A significant majority of CHD patients possess at least one conventional risk factor: 84.6% of women and 80.6% of men.
- In younger patient groups and those with unstable angina or undergoing PCI, only 10-15% lacked any of the four conventional risk factors.
- Cigarette smoking was a key factor in premature CHD for men, while both smoking and diabetes were significant for women. Smoking reduced the age of CHD onset by approximately one decade.
Conclusions:
- Contrary to popular belief, 80-90% of patients with coronary heart disease (CHD) do have conventional risk factors.
- While non-traditional factors and genetics warrant research, clinical practice and public health initiatives must strongly focus on conventional risk factors and associated lifestyle behaviors.
- Emphasizing conventional risk factors is crucial for reducing the epidemic of CHD.
Context:
It is commonly suggested that more than 50% of patients with coronary heart disease (CHD) lack any of the conventional risk factors (cigarette smoking, diabetes, hyperlipidemia, and hypertension). This claim implies that other factors play a significant role in CHD and has led to considerable interest in nontraditional risk factors and genetic causes of CHD.
Objective:
To determine the prevalence of the 4 conventional risk factors among patients with CHD.
Design, Setting, And Patients:
In 2002-2003, we analyzed data for 122458 patients enrolled in 14 international randomized clinical trials of CHD conducted during the prior decade. Patients included 76716 with ST-elevation myocardial infarction, 35527 with unstable angina/non-ST-elevation myocardial infarction, and 10215 undergoing percutaneous coronary intervention.
Main Outcome Measures:
Prevalence of each conventional risk factor and number of conventional risk factors present among patients with CHD, compared between men and women and by age at trial entry.
Results:
Among patients with CHD, at least 1 of the 4 conventional risk factors was present in 84.6% of women and 80.6% of men. In younger patients (men < or =55 years and women < or =65 years) and most patients presenting either with unstable angina or for percutaneous coronary intervention, only 10% to 15% of patients lacked any of the 4 conventional risk factors. This pattern was largely independent of sex, geographic region, trial entry criteria, or prior CHD. Premature CHD was related to cigarette smoking in men and cigarette smoking and diabetes in women. Smoking decreased the age at the time of CHD event (at trial entry) by nearly 1 decade in all risk factor combinations.
Conclusions:
In direct contrast with conventional thinking, 80% to 90% of patients with CHD have conventional risk factors. Although research on nontraditional risk factors and genetic causes of heart disease is important, clinical medicine, public health policies, and research efforts should place significant emphasis on the 4 conventional risk factors and the lifestyle behaviors causing them to reduce the epidemic of CHD.
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