Coronary artery disease risk factors

Toxicity-. Vital signs (pulse, blood pressure), electrocardiogram, particularly in patient with coronary artery disease risk factors... 

Content of medical surveillance, (i) Medical and work history. The comprehensive medical and work history shall emphasize neurological symptoms, skin conditions, history of hematologic or liver disease, signs or symptoms suggestive of heart disease (angina, coronary artery disease), risk factors for cardiac disease, MC exposures, and work practices and personal protective equipment used during such exposures. 

Banz, W.J., Maher, M.A., Thompson, W.G., Bassett, D.R., Moore, W., Ashraf, M., Keefer, D.J., and Zemel, M.B. (2003). Effects of resistance versus aerobic training on coronary artery disease risk factors. Exp Biol Med (Maywood) 228 434-440. 

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

The risk of gout increases as the serum uric acid concentration increases, and approximately 30% of patients with levels greater than 10 mg/dL (greater than 595 pmol/L) develop symptoms of gout within 5 years. However, most patients with hyperuricemia are asymptomatic. Other risk factors for gout include obesity, ethanol use, and dyslipidemia. Gout is seen frequently in patients with type 2 diabetes mellitus and coronary artery disease, but a causal relationship has not been established. 

Moatti D, Faure S, Fumeron F, et al. Polymorphism in the fractalkine receptor CX3CR1 as a genetic risk factor for coronary artery disease. Blood 2001 97(7) 1925-1928. 

Hypertension, or a chronic elevation in blood pressure, is a major risk factor for coronary artery disease congestive heart failure stroke kidney failure and retinopathy. An important cause of hypertension is excessive vascular smooth muscle tone or vasoconstriction. Prazosin, an aradrenergic receptor antagonist, is very effective in management of hypertension. Because oq-receptor stimulation causes vasoconstriction, drugs that block these receptors result in vasodilation and a decrease in blood pressure. 

Lipoprotein (a) is an independent risk factor for coronary artery disease [68]. It consists of two components an LDL particle and apolipoprotein (a) which are linked by a disulfide bridge. Apo(a) reveals a genetically determined size polymorphism, resulting from a variable number of plasminogen kringle IV-type repeats [69]. Statins either do not affect Lp(a) or may even increase Lp(a) [70, 71]. In a study of 51 FH patients, treated with 40 mgd 1 pravastatin, it has been shown that the increase in Lp(a) was greatest in patients with the low molecular-weight apo(a) phenotypes [70]. 

Marcovina SM, Koschinsky ML. Upo-protein(a) as a risk factor for coronary artery disease. Am J Cardiol 1998 82 57U-66U. 

It is well known that high concentrations of LDL, specifically oxidized LDL, are risk factors for coronary artery disease. This fact is explained by the oxidative hypothesis of atherogenesis. According to this hypothesis, the atheroma is formed by foam cells from the vascular subendothelium that derive from macrophages that have picked up previously oxidized LDL in an uncontrolled manner. These lipoproteins are cytotoxic to the endothelium and, in addition, chemotactic to macrophages and monocytes,... 

Women with controlled dyslipidemias can use low-dose CHCs, with periodic monitoring of fasting lipid profiles. Women with uncontrolled dysiipidemia (LDL greater than 160 mg/dL, HDL less than 35 mg/dL, triglycerides greater than 250 mg/dL) and additional risk factors (e.g., coronary artery disease, diabetes, hypertension, smoking, or a positive family history) should use an alternative method of contraception. 

It is well-established that an elevated level of cholesterol, particnlarly that carried largely in the form of LDLs, is an independent risk factor for the development of atherosclerosis and its sequelae, including coronary artery disease (leading to heart attacks), strokes, and peripheral arterial disease. 

The clinical problems that arise in the menopause are hot flushes, sweating, depression, decreased libido, increased risk of cardiovascular disease and osteoporosis. The latter results in increased incidence of hip, radial and vertebral fractures. Oestrogen is one factor controlling synthesis of active vitamin D and osteoporosis is in part due to a deficiency of vitamin D. Not surprisingly, to reduce these problems, administration of oestrogen is recommended (known as hormone replacement therapy or HRT). HRT reduces some of the risk factors for coronary artery disease since it reduces blood pressure and decreases the blood level of LDL-cholesterol and increases that of HDL-cholesterol. However, there is considerable debate about whether HRT increases the risk of breast or endometrial cancer. 

In a totally different field, studies were being carried out on children who had a deficiency of methionine synthase and an impaired ability to convert homocysteine to methionine, so that they had increased blood levels of homocysteine. It was noted that these children had an increased incidence of thrombosis in cerebral and coronary arteries. This led to a study which eventually showed that an increased level of homocysteine was a risk factor for coronary artery disease in adults. Since methionine synthase requires the vitamins, folic acid and B12, for its catalytic activity, it has been suggested that an increased intake of these vitamins could encourage the conversion of homocysteine to methionine and hence decrease the plasma level of homocysteine. This is particularly the case for the elderly who are undernourished (see Chapter 15 for a discussion of nutrition in the elderly). 

Deepa R, Deepa K, Mohan V. (2002) Diabetes and risk factors for coronary artery disease. Curr Sci 83 1497-1505. 

Ml-M risk associated with OC use is increased. This risk is primarily in smokers or women with other underlying risk factors for coronary artery disease such as hypertension, hypercholesterolemia, morbid obesity, and diabetes. The risk is very low in women younger than 30 years of age. Long-term use - Data suggest that the increased risk of Ml persists after discontinuation of long-term OC use the highest risk group includes women 40 to 49 years of age who used OCs for 5 years or more. 

Reduction in risk of Ml, stroke, and death from cardiovascular causes - In patients 55 years of age or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor (eg, hypertension, elevated total cholesterol levels, low FIDL levels, cigarette smoking, documented microalbuminuria). 

And while the data on coronary artery disease are sobering, in many ways they merely represent the tip of the iceberg when considering the prevalence of risk factors for coronary artery disease (Fig. 1.6). Obesity and diabetes are approaching epidemic proportions (Fig. 1.7). Seven out of every ten American adults are considered overweight (BMI > 25) and three out of ten are obese (BMI > 30) [7]. The prevalence of obesity has increased 75%... 

Coronary artery disease/number of risk factors Smoking... 

Vasa M, Fichtlscherer S, Aicher A, Adler K, Urbich C, Martin H, Zeiher AM, Dimmeler S. Number and migratory activity of circulating endothelial progenitor cells inversely correlate with risk factors for coronary artery disease. Circ Res 2001 89 El-7. 

Hill JM, Syed MA, Aral AE, Powell TM, Paul ID, Zalos G, Read EJ, Khuu HM, Lehman SF, Horne M, Csako G, Dunbar CE, Waclawiw MA, Cannon RO 3rd. Outcomes and risks of granulocyte colony-stimulating factor in patients with coronary artery disease. J Am Coll CarJlo/2005 46 1643-1648. 

Furthermore, polyphenolics present in wine, of which flavonoids are important components, have been suggested to be responsible of the so called French paradox, that is, the unexpectedly low rate of mortality from coronary heart disease in French population despite an unfavourable exposure to known cardiovascular risk factors such as high saturated fat consumption [19-21]. Epidemiological studies in USA [22] and Denmark [23] reported that moderate red wine drinkers had a lower risk of coronary artery disease than participants with no alcoholic beverage preference. However, controversial results about the antioxidant capacity of human serum after red wine consumption have been reported [24-27]. It is therefore uncertain whether wine constituents other than alcohol add to the cardioprotective effects of red wine. 

Turner, R.C., et al. 1998. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus United Kingdom Prospective Diabetes Study (UKPDS 23). Br Med J 316 823. 

Subjects suffering from coronary artery disease were given two capsules containing 300 mg of grape procyanidin extracts (Leucoselect-phytosome) or placebo daily for 5 days. TAC of their blood serum was reported to increase on day 5 from 408.1 22.9 to 453.3 453.3 /u.M) however, samples were taken 1 hr postdose and most probably the results indicate a transient rather than a permanent effect (N10). In a 6-month randomized controlled intervention study, subjects with moderately increased cardiovascular risk factors (1) adhered to an advised diet, (2) performed controlled moderate exercise, (3) were subjected to both diet and exercise regime, or (4) were not subjected to any intervention. No significant alteration in blood serum TAC was observed in any group tested (R22). 

---