CardiologyTier 2Topic

The incidence of, and the risk factors for, cardiovascular disease in individuals and patient groups - patients with risk factors for atherosclerotic vascular disease

Overview

The major modifiable and non-modifiable risk factors for atherosclerotic cardiovascular disease, and how they are used in formal risk stratification
Cardiovascular disease remains the leading cause of death globally; the great majority of risk is attributable to a small number of well-characterised modifiable factors

Non-modifiable: age, sex (male, and post-menopausal female), family history of premature CVD (first-degree relative <55y male/<65y female)
Modifiable: smoking, hypertension, dyslipidaemia (elevated LDL, low HDL), diabetes/insulin resistance, obesity, physical inactivity, poor diet
Emerging/additional risk markers: lipoprotein(a) (largely genetically determined, not modified by standard lipid therapy other than some newer agents), coronary artery calcium score, family history-driven genetic risk beyond conventional factors

Formal risk calculators (Framingham-derived, pooled cohort equations, or country-specific tools) combine these factors into an absolute 5- or 10-year cardiovascular risk estimate, used to guide the intensity of primary prevention (statin initiation thresholds, BP targets)

Risk factor modification intensity is matched to calculated absolute risk, not any single factor in isolation - a patient with several mildly abnormal factors can have higher absolute risk than one with a single markedly abnormal factor

Metabolic syndrome, familial hypercholesterolaemia (a specific high-risk genetic cause of dyslipidaemia), smoking cessation programs

Risk factor burden is cumulative and multiplicative rather than simply additive - the combination of several moderate risk factors together confers materially higher risk than any factor considered in isolation

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