What are atherosclerotic risk factors?

Updated: Jul 24, 2019
  • Author: J Bayne Selby, Jr, MD; Chief Editor: Eugene C Lin, MD  more...
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Atherosclerotic risk factors have been evaluated in multiple longitudinal epidemiologic studies, such as the Framingham Heart Study. These studies have defined advancing age, male sex (or better stated, the absence of protective female hormones), hypertension, dyslipidemias, diabetes, cigarette smoking, and family history as predictors of subsequent cardiac events and angiographically demonstrated coronary artery disease. [1, 2, 3]

When x-rays were discovered, calcium was again recognized as a disease marker. In fact, for most of the 20th century, calcium, because of its density, was the only feature that stood out on radiographs of the heart. In the 1950s, heart disease became more recognized as a significant cause of mortality in the United States. Along with this recognition came numerous publications about the ability to detect calcifications in the coronary arteries with radiography. In some ways, this period can be thought of as the first age of importance for calcium detection in the heart.

This period came to an end with the widespread acceptance of coronary angiography and other less invasive tests, such as stress thallium testing. If an actual stenosis or area of ischemia could be detected, attempts to qualitatively detect calcium with radiography or fluoroscopy seemed primitive. The advent of angioplasty and stent placement in the treatment of arterial stenoses seemed to herald the end of calcium detection.

Tremendous overlap exists, and sensitivities and specificities vary, even when multiple risk factors are applied. Novel risk factors have been proposed in an effort to enhance disease detection, particularly in asymptomatic patients. As a result, clinicians now may measure levels of homocysteine, fibrinogen, lipoprotein subunits (eg, lipoprotein A), C-reactive protein, and other biochemical markers of coronary atherosclerosis and subsequent cardiovascular events.

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