Risk factors for atherosclerotic vascular disease

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Risk Assessment

Background:

• Evidence supports anti-hypertensive and hypolipidaemic drugs for coronary heart disease (CHD) prevention.
• International guidelines recommend specific blood pressure (<140/90 mm Hg) and LDL-cholesterol (<2.6 mmol/l) targets for manifest CHD.
• Secondary prevention strategies now focus on pre-symptomatic, high-risk individuals.

Purpose of the Study:

• To outline current guidelines for CHD prevention, including tertiary and secondary prevention.
• To detail the conventional risk factors used in CHD risk assessment.
• To explore the role of novel risk factors, such as C-reactive protein, in refining risk prediction.

Main Methods:

• Review of controlled interventional trials and international guidelines for CHD prevention.
• Description of conventional cardiovascular risk factors (sex, age, smoking, diabetes, lipids, blood pressure).
• Discussion of risk scores and algorithms for calculating absolute myocardial infarction risk.
• Evaluation of C-reactive protein as a novel risk factor for improving prognostic value.

Main Results:

• Established guidelines recommend strict blood pressure and LDL-cholesterol control in patients with CHD.
• Risk stratification for secondary prevention involves assessing morbidity risk (>20%) and mortality risk (>5%) over 10 years.
• Conventional risk factors are used to compute absolute myocardial infarction risk.
• High C-reactive protein levels enhance the prognostic value of global risk estimates, particularly for intermediate-risk patients.

Conclusions:

• Current guidelines effectively manage manifest CHD and identify high-risk pre-symptomatic individuals.
• Novel risk factors, like C-reactive protein, offer potential to improve cardiovascular risk prediction and guide treatment decisions.
• Accurate risk assessment is crucial for tailoring preventive strategies in coronary heart disease.