RISK FACTORS FOR CARDIOVASCULAR DISEASE (CVD)

Katia Liceth Aconcha

Program of Degree in Natural Science and Environmental Education

Popular University of Cesar

Summary

            After consulting various sources on cardiovascular diseases in scientific articles, it was decided to produce a document that details the risk factors for cardiovascular disease (CVD). In the area of the medicine, the assessment of the cardiovascular risk allows to identify the groups in which is necessary give priority to prevention activities to reduce cardiovascular morbidity (Solon et al., 2009). It was found that suffer from high blood pressure, diabetes, have the habit of smoking and an inadequate diet increases the likelihood of suffer a CVD.

Key Words: Study, cardiovascular disease, risk factors.

Introduction

            In the western societies and in some cultures with emerging economies, prevail the CVD whose underlying pathology is the atherosclerosis and the arterial thrombosis. Within these diseases include, among others, the ischemic heart disease, the majority of the brain-vascular diseases, hypertensive disease, part of the heart failure, some aneurysms and arterial thrombosis (Sanz, 2006).

            According to the World Health Organization, cardiovascular disease (CVD) is one of the greatest public health problems in the world, is the first cause of mortality by cause of 17 million deaths a year. CVD is responsible for 32 million coronary events and brain-vascular accidents, of which between 40-70 per cent are fatal in developed countries. It is estimated that this problem is much greater in developing countries and it is considered that millions of people suffer the risk factors that are not commonly diagnosed, such as high blood pressure, smoking, diabetes, high blood lipids, inadequate diet (WHO, 2002).

            Alarmingly, in the last decade, the CVD has been increasing as a cause of morbidity and mortality in countries with low and middle-income; in part due to the effects of globalization mid by the aggressive marketing and mass communications that invite to the new populations to the lifestyles of risk (smoking, alcohol consumption, unhealthy diets) (Advisory Board, 2004).     

            The cardiovascular risk is defined as the probability of developing a cardiovascular disease (coronary artery disease, vascular brain attack or peripheral artery disease) in a time period of ten years. The assessment of cardiovascular risk allows us to know those groups in where there should be increased the prevention activities and pharmacological and non-pharmacological interventions aimed at reducing the morbidity and mortality rates from cardiovascular disease (Solon et al., 2009).

            The concept of risk factor for CVD applies to those biological signs and acquired habits that have been found with greater frequency among patients with heart disease in relation to the general population, thus allowing the identification of population groups with higher risk of having the disease in the next years (Manzur and Arrieta, 2005). At present, the risk factors for CVD have been grouped into factors modifiable and not modifiable. The modifiable are those that are susceptible to change, for the improving the lifestyle or pharmacologic therapy. And the not modifiable are those impossible to change such as age, gender and inheritance (Pearson, 2002).

             The Hypertension, hypercholesterolemia, and smoking are the three modifiable cardiovascular risk factors of greater relevance. Diabetes, physical inactivity, obesity or overweight and the excessive consumption of alcohol are other factors that are considered as modifiable or controllable (Chobanian, 2003). These risk factors are responsible for 75 % of the epidemic of CVD in the world; however, the importance of each risk factor is relative and can vary in different populations (WHO, 2002). The identification of these factors, and their distribution in the population is important given that there is evidence that to take actions against these factors, the risk for CVD can be decreased significantly (Bakhru and Erlinger, 2005; Magnus and Beaglehole, 2001).

Assessment of Global Cardiovascular Risk

            Has been established methods for the assessment of global cardiovascular risk that classify to the patient in a category that allows to determine the prognosis and establish therapeutic goals. The treatment of risk factors present must be assumed in a comprehensive manner (Ruiz, 2007).           

            Are recognized several ways to measure cardiovascular risk, of accordance to the population evaluated, among which are the method proposed by the ATP III based on the monitoring of Framingham (NCEP, 2002); SCORE (Baker et al., 2003) of European origin and other forms that may be useful, such as the derivative of the PROCAM study conducted in Germany (Assmann et al., 2002).

            In Latin America, are basically used two methods for the assessment of cardiovascular risk: the proposed by the ATP III and automatic classification. This last is when the patient has conditions what makes evident its risk, and is the first classification that should be considered for the patient (Ruiz, 2007).

Automatic Classification

1.    Classification at very high risk

·         Patients with coronary disease, cerebral vascular or peripheral vascular and any of the following conditions: diabetes mellitus, acute coronary syndrome, as well as risk factors of difficult control or metabolic syndrome.

2.    Classified in Global Risk High

·         History of coronary disease.

·         History of brain-vascular disease.

·         History of atherosclerotic peripheral vascular disease.

·         Patients with type 2 Diabetes Mellitus with some additional risk factor.

3.     Classified automatically under Global Intermediate Risk

·         Patients with metabolic syndrome diabetic

·         Patients mellitus type 2 without other factors of risk

4.    Classification in Latent Risk

·         A factor of risk

If precedents do not exist for the automatic classification of the patient there is applied the index of risk proposed by the ATP III. This takes into account the patient's age, total cholesterol, smoking, HDL cholesterol, and blood pressure. It also takes into account the sex, as there are different tables for men and women (Moreno, 2009).

Factors of cardiovascular risk

            Exist factors of cardiovascular risk not preventable or modifiable as the age, the sex and familiar precedents of cardiac premature disease (before 55 years in men and before 65 years in women) (Ruíz, 2007). Between the modifiable factors of risk or, better still, preventable there exist some that have major impact in the cardiovascular disease and that explain the majority of the resultant risk, principal factors called: Dyslipidemia, smoking, metabolic syndrome, arterial hypertension and diabetes mellitus. Exist other additional factors such as: inactivity, psychosocial stress, inappropriate diet and alcoholism.

            There are other factors, such as: left ventricular hypertrophy, the increased levels of lipoprotein (a), the increased levels of homocysteine, microalbumin, elevated levels of the inhibitor of the activation of plasminogen 1 or of fibrinogen, the polymorphism of factor VII of the coagulation, and hyperinsulinism, among others, that they have little weight in the calculation of the overall risk, or for that there has not been demonstrated that an intervention that modifies them changes, in an independent way, the risk of significant form (Ruíz, 2007).

            There are also some factors with predictive power, which are markers of risk: the high sensitivity C-reactive protein, the relationship Total cholesterol/HDL ratio or the LDL/HDL-c (Ridker et al., 2007; Jukema et al., 2005).  In the case of C-reactive protein, some authors have recently discovered mechanisms by which the increase in PCR can initiate inflammatory reactions and cause tissue injury, by what his role would not be so innocent (Danenberg et al. , 2007; Ryu et al. , 2007). 

Conclusions

1. There are multiple cardiovascular risk factors that accompany the population, such as smoking, high blood pressure or obesity.

2. At the global level it has been noted the increase in numbers of CVD deaths.

3. It has been found that the affect CVD in greater proportion to the females than males.

4. The bad habits of life, can reach to involve in his time to the incidence of suffer a CVD.

5. The modification of risk factors has been shown to reduce mortality and morbidity in patients with and without cardiovascular disease (Baker et al., 2003).

6. The risk factors have been classified as modifiable and not modifiable.

References

·         Advisory Board (2004). The Milan declaration: positioning technology to serve global heart health. 5th International Heart Health Conference.

·         Assmann G, Cullen P y Schulte H (2002). Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study.

·         Bakhru A y Erlinger T (2005). Smoking cessation and cardiovascular disease risk factors: results from the Third National Health and Nutrition Examination Survey.

·         Chobanian A, Bakris G, Black H, Cushman W, Green L, Izzo J, et al. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.     

·         De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J,            et al. (2003). European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice.

·         Moreno L (2009).  Prevalence of the major risk factors for cardiovascular disease and cardiovascular risk in patients with hypertension who are attending a IPS in Bogota and some municipalities of Cundinamarca. Colombia.

·         Magnus P y Beaglehole R (2001). The real contribution of the major risk factors to the coronary epidemics: time to end the "only-50%" myth.   

·         Manzur F and Arrieta C (2005).  Sociological study and knowledge of the risk factors for cardiovascular diseases in the Colombian Caribbean Coast).

·         National Cholesterol Education Program (NCEP) (2002). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).

·         Pearson T, Blair S, Daniels S, Eckel R, Fair J y Fortmann S (2002). AHA guidelines for primary prevention of cardiovascular disease and stroke.

·         Ruiz (2007).  Manual of Diagnosis and treatment of dyslipidemia.

·         Sans S (2006).  Cardiovascular Diseases.

·         Solon H, Huertas D, Rozo L and Ospina J (2009).  Prevalence of risk factors for cardiovascular disease in a sample of patients with essential hypertension: A descriptive study.

·         World Health Organization. The World Health report 2002: reducing risks, promoting healthy life. Geneva, Switzerland.