What are the risk factors for coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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A number of large epidemiologic studies in North America and Europe have identified numerous risk factors for the development and progression of atherosclerosis. These factors, which can be classified as either modifiable or nonmodifiable, include the following:

  • Hyperlipidemia and dyslipidemia

  • Hypertension

  • Cigarette and tobacco use

  • Air pollution

  • Diabetes mellitus

  • Age

  • Sex

  • Family history

  • Obesity

  • Sedentary lifestyle

  • Sleep disorders, such as obstructive sleep apnea

  • Chronic kidney disease

  • Auto-immune inflammatory diseases such as rheumatoid arhtritis and systemic lupus

The American College of Cardiology Foundation/American Heart Association 2010 report on cardiovascular risk assessment in asymptomatic adults recommends global risk scoring (eg, Framingham Risk Score [9] ) and a family history of cardiovascular disease be obtained in all adult women and men. [10]

Numerous novel risk factors have been identified that add to the predictive value of the established risk factors and may prove to be a target for future medical interventions.

Risk factors specific to women include pregnancy and complications of pregnancy such as gestational diabetes, preeclampsia, third trimester bleeding, preterm birth, and birth of an infant small for gestational age. The 2011 update to the American Heart Association guideline for the prevention of cardiovascular disease (CVD) in women recommends that risk assessment at any stage of life include a detailed history of pregnancy complications. It also states that postpartum, obstetricians should refer women who experience these complications to a primary care physician or cardiologist. [11]

The presence of risk factors accelerates the rate of development of atherosclerosis. Diabetes causes endothelial dysfunction, decreases endothelial thromboresistance, and increases platelet activity, thus accelerating atherosclerosis.

Established risk factors successfully predict future cardiac events in about 50-60% of patients. A concerted effort to identify is also being made to validate new markers of future risk of the clinical consequences of atherosclerosis has been made.

Other risk factors for coronary artery atherosclerosis include the following:

  • Family history of premature CAD

  • Hypoalphalipoproteinemia

  • Syndromes of accelerated atherosclerosis - Graft atherosclerosis, CAD after cardiac transplantation

  • Chronic kidney disease [12]

  • Systemic lupus erythematosus [13]

  • Rheumatoid arthritis [14]

  • Metabolic syndrome [15]

  • Chronic inflammation

  • Infectious agents

  • Increased fibrinogen levels

  • Increased lipoprotein(a) levels

  • Familial hypercholesterolemia

  • Depression

According to the 2011 update to the American Heart Association guideline for CVD prevention in women, risk factors that are more common or may be more significant in women include psychosocial factors such as depression and autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. The Heart and Estrogen/progestin Replacement Study evaluated the effects of hormone replacement therapy on cardiovascular events among postmenopausal women with CAD and found that sudden cardiac death comprised most cardiac deaths among this group of women. [16] Women with these conditions should be evaluated for CVD and for other risk factors. Women with clinically evident CVD should also be screened for these conditions, which can affect adherence or otherwise complicate secondary CVD prevention efforts. [11]

A study by Semba et al, however, suggests that high concentrations of plasma klotho, a recently discovered hormone that has been implicated in atherosclerosis, are independently associated with a lower likelihood of having CVD. [17]

For more information, see Risk Factors for Coronary Artery Disease.

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