1. RISK FACTOR FOR CORONARY ARTERY DISEASE
Dr.Animesh Mishra; MD (BHU), DM (Delhi University).
Associate Professor, Department of cardiology
NEIGRIHMS,Shillong-12

2. PURPOSE OF THIS VEDIO-CONFERENCING
Dissemination of information relative to the prevention
of atherosclerosis and its adverse consequences.
Development of educational pro-grams specific to the
role of the cardiovascular specialist with regard to
prevention.
Cooperative development of practice guidelines, for
consultative as well as rehabilitation services, to
deliver cost-effective preventive care.
Policies of fair reim-bursement for effective services.
Participation in the assessment of clinical outcomes of
such programs.

3. Cont.... To promote preventive cardiac care by
Endorsing anti-smoking policies & programs.
Encouraging healthy dietary behavior.
Promoting prudent physical activity.
Ensuring adequate control of blood pressure.
Managing patients with hyperlipidemia,
metabolic, coagulative and other risk factors.
Advising primary care physicians with regard to risk reduction.
Developing a cardiovascular health promotion plan for cardiac patients and their families.

4. Definition of CHD
Framingham definition: Angina pectoris, recognized and unrecognized MI,USA,& CHD deaths.
Recent Framingham report :“Hard" CHD excludes angina pectoris.)
(AFCAPS/Tex CAPS): Specified acute coronary events as USA, AMI & coronary death.

5. Major Independent Risk Factors AHA/ACC Scientific Statement:
Cigarette smoking Elevated blood pressure Elevated serum total (and LDL) cholesterol Low serum HDL cholesterol Diabetes mellitus Advancing age

6. Other Risk Factors
Predisposing risk factors    Obesity    Abdominal obesity    Physical inactivity    Family history of premature coronary heart
disease    Ethnic characteristics    Psychosocial factors
*These risk factors are defined as major risk factors by the AHA .
Cont….

7. Conditional risk factors
   Elevated serum triglycerides    Small LDL particles    Elevated serum homocysteine    Elevated serum lipoprotein (a)    Prothrombotic factors (eg, fibrinogen)    Inflammatory markers (eg, C-reactive protein)

8. MENTAL STRESS,DEPRESSION,AND CARDIOVASCULAR RISK
From Clinician’s perspective-As a modifiable risk factor
1- Acute stress
2- Work related stress
(a)-Job strain
(b)-Effort-reward imbalance
3-Psychological metrics.

9. Cont…. In a meta-analysis of 11 studies of healthy individuals
Depressive mood. (RR-1.7)
Clinical depression.(RR-2.3)
Whether therapy for post-infarction
depression reduces recurrent event rates
remains controversial

10. Body weights BMI Normal weight : 18.5–24.9 kg/m2
Overweight : –29 kg/m2;
Obesity : >30.0 kg/m2
class I 30.0–34.9
class II 34.9–39.9,
class III ≥40 kg/m2).
Abdominal obesity is defined according
waist circumference: men >102 cm (>40 in)
&women >88 cm (35 in)

11. Clinical Importance of Global Estimates for CHD Risk
Total (global) risk summation of all major
risk factors can be clinically useful for
3 purposes:
1) Identification of high-risk patients who deserve
immediate attention and intervention,
2) Motivation of patients to adhere to risk-reduction
therapies.
3) Modification of intensity of risk-reduction efforts
based on the total risk estimate.

12. Primary Versus Secondary Prevention
This presentation focuses mainly on risk assessment
for coronary disease and not on risk for
cardiovascular outcomes.
Framingham scores estimate risk for persons without clinical manifestations of CHD Therefore, the scores apply only to primary prevention.
Once coronary atherosclerotic disease becomes clinically manifest, the risk for future coronary events is much higher than that for patients without CHD regardless of other risk factors, and in this case, Framingham scoring no longer applies.

13. Severity of Major Risk Factors
The scoring does not adequately account for severe abnormalities of risk factors,e.g. severe hypertension, severe hypercholesterolemia, or heavy cigarette smoking. This underestimation is particularly evident when only 1 severe risk factor is present.
Thus, heavy smoking or severe hypercholesterolemia
can lead to premature CHD even when the summed score for absolute risk is not high. Likewise, the many dangers of prolonged, uncontrolled hypertension are
well known.

14. Diabetes Mellitus as a Special Case in Risk Assessment
Both type 1 and type 2 diabetes confer a
heightened risk for CVD.
When the risk factors of diabetic patients are summed, their
risk often approaches that of patients with established CHD.
Considerations about the very high risk of patients with
diabetes apply to ethnic groups that have a relatively high
population risk for CHD.
Inclusion of patients with type 2 diabetes in the very-high-risk
category may not be appropriate when they belong to ethnic
groups with a low population risk.

15. Definition of a Low-Risk State
Serum total cholesterol: 160 to 190
LDL-C :100 to 129
HDL-C: >45 in men and >55 in women
Blood pressure: <120 mm Hg systolic
and <80 mm Hg diastolic
Non Smoker
No diabetes mellitus

16. IDEAL GOAL FOR INDIVIDUALS
Serum total cholesterol: 100 to 130
LDL-C :<80
HDL-C: > 80
Blood pressure: <115 mm Hg systolic
and <75 mm Hg diastolic
Non Smoker
No diabetes mellitus