Risk Factors for Coronary Artery Disease

Excerpt

Coronary artery disease (CAD) accounts for approximately 610,000 deaths annually (estimated 1 in 4 deaths) and is the leading cause of mortality in the United States. It is the third leading cause of mortality worldwide and is associated with 17.8 million deaths annually. In the United States, healthcare services for CAD are estimated to cost more than 200 billion dollars annually. While CAD is a significant cause of death and disability, it is preventable.

The Framingham Heart Study enrolled its first participant in 1948 and is currently studying its third generation of participants. This was the first study that elucidated risk factors associated with cardiovascular disease. Since then, cohort studies have continued to study the impact of different risk factors on cardiovascular disease. The FINRISK study is an ongoing Finnish population-based observational study that began in 1972. The ULSAM, PIVUS, POEM, EpiHealth, and SCAPIS were cohort studies completed at Uppsala University in Sweden. The PREDICT Cardiovascular Disease Cohort study was another study completed in New Zealand. These studies classify CAD into 2 broad categories: non-modifiable and modifiable risk factors. Non-modifiable risk factors include age, gender, ethnicity, and family history of CAD. Modifiable risk factors include hypertension, hyperlipidemia, diabetes, obesity, smoking, poor diet, sedentary lifestyle, and stress.

Given the immense healthcare burden of CAD, modifiable and non-modifiable risk factors were identified to mitigate the resulting economic and disease-related burden. Risk factor identification, combined with advances in medical technology, has significantly decreased CAD mortality rates over the past forty years in Western countries. One public health study that gathered mortality data from 1969 to 2014 concluded that by 2020, the number of heart disease-related deaths would decrease by 21.3 percent for men and 13.4 percent for women. This topic reviews the impact and management of these risk factors. Ever since the Framingham Heart Study, there has been a plethora of data on CAD risk factors. This topic concisely summarizes the most recent systemic reviews and evidence.