Sunday, August 4, 2013

Coronary Heart Disease Risk Factors

There are factors which can cause or trigger Coronary Heart Disease:
1. Lipid
        Dyslipidemia believed to be the major risk factors that can be modified for the development and progressive changes in the occurrence of coronary heart disease. Cholesterol is transported in the blood in the form of lipoproteins, 75% is a low-density lipoprotein (low density liproprotein / LDL) and 20% is a high density lipoproteins (high density liproprotein / HDL). HDL-cholesterol was lower has a good role in coronary heart disease and there is an inverse relationship between HDL levels and the incidence of coronary heart disease.

            In the middle-aged men (45 to 65 years) with high levels of serum cholesterol (cholesterol:> 240 mg / dL and LDL cholesterol:> 160 mg / dL) the risk of coronary heart disease will increase.
Therapy with pravastatin can reduce average levels of LDL cholesterol by 32%, of patients who received treatment with pravastatin protected from coronary heart disease events by 24% compared with the placebo group.
        In addition, studies conducted by experts mention that omega-3 fatty acids can lower LDL cholesterol, reduce triglyceride levels and increase HDL cholesterol. Some vitamins alleged to have protective effects against atherosclerosis, one of which is vitamin C and E as an antioxidant to prevent lipid oxidation in plaque.


2. Smoke
         Smoking is a major risk factor for heart disease, including heart attack and stroke, and also has a strong relationship to the occurrence of coronary heart disease, so that by quitting smoking will reduce the risk of heart attack. Cigarette smoking increases the risk of heart attack as much as 2 to 3 times. Approximately 24% of deaths from coronary heart disease in men and 11% in women due to smoking habits. Although there is a progressive decline in the proportion of the population who smoke since the 1970s, in 1996 by 29% of men and 28% of women still smoke. One thing of concern is the increasing prevalence of cigarette smoking in adolescents, especially in girls. People who do not smoke and live with smokers (passive smokers) have an increased risk of 20-30% compared with those who lived with nonsmokers. The risk of coronary heart disease due to smoking-related doses where people who smoke 20 cigarettes a day had a risk or more by two to three times higher than the general population to experience coronary heart disease events.
 
Role in the pathogenesis of cigarette coronary heart disease is the
complex, including:
a. The onset of atherosclerosis.
b. Increased thrombogenesis and vasoconstriction (including coronary artery spasm)
c. Increased blood pressure and heart rate.
d. Cardiac arrhythmia provocation.
e. Increase in myocardial oxygen demand.
f. Decrease in oxygen-carrying capacity.
g. The risk of coronary heart disease due to smoking dropped to 50% after one year of quitting smoking and become normal after 4 years of stopping.
Smoking is also a major risk factor in the occurrence of: respiratory disease, gastrointestinal tract, liver cirrhosis, bladder cancer and a decrease in physical fitness.

        Benefits of smoking cessation less controversy than diet and exercise. Three randomized studies on smoking habits was conducted on primary prevention programs and demonstrate a decrease in vascular events as much as 7-47% in the group are able to stop smoking than those who did not. Therefore smoking cessation advice is a major component in coronary heart rehabilitation program.

3. Obesity
          There is interplay between obesity and increased risk of coronary heart disease, hypertension, angina, stroke, diabetes and a significant burden on the health of the heart and blood vessels. Data from the Framingham showed that if each individual has an optimal weight, will decrease the incidence of coronary heart disease and stroke by 25% / cerebrovascular accident (CVA) by 3.5%. Expected weight loss can lower blood pressure, improve insulin sensitivity, and glucose burning
reduce dyslipidemia. It is reached by way of reducing calorie intake and increase physical activity. Besides providing a list of food composition, the patient is also expected to consult with a dietician on a regular basis.
 
4. Diabetes Mellitus
        Patients with diabetes, coronary heart disease will suffer a more severe, more progressive, more complex, and more diffuse than the control group with the appropriate age. Diabetes mellitus is associated with physical changes in the cardiovascular system pathology. Among them may be endothelial dysfunction and vascular disorders, which in turn increases the risk of coronary artery diseases (CAD). This condition can result in microangiopathic, cardiac muscle fibrosis, and abnormalities of the heart muscle metabolism.
          The risk of coronary heart disease in patients with NIDDM (Non Insulin Dependent Diabetic Mellitus) is two to four times higher than the general population and seems to be unrelated to the severity or duration of diabetes, perhaps due to the presence of insulin resistance may precede the onset of clinical symptoms 15-25 previous year. Another source said that, patients with a greater risk of diabetes mellitus (200%) for the occurrence of diseases cardiovascular in individuals who are not diabetic.
        Diabetes, although an independent risk factor for coronary heart disease, is also associated with abnormalities of lipid metabolism, obesity, systemic hypertension and increased thrombogenesis (increased levels of platelet adhesion and fibrinogen levels). Results of coronary artery bypass grafting (CABG) is not very good long-term in diabetics, and diabetic patients have an increased risk of early mortality and recurrent stenosis after coronary angioplasty.
 
5. Family History
         Familial and genetic factors have a significant role in the pathogenesis of coronary heart disease, it is also used as an important consideration in the diagnosis, treatment and prevention of coronary heart disease. Coronary heart disease can sometimes be a manifestation of a specific single-gene disorders associated with the occurrence of atherosclerotic mechanisms.
         Family history of coronary heart disease in families with direct blood relatives younger than 70 years is an independent risk factor for the occurrence of coronary heart disease, the odds ratio of two to four times greater than in the control population. Aggregation of coronary heart disease families indicates a genetic predisposition to this condition. There is some evidence that a positive family history may influence the age of onset of coronary heart disease in the immediate family.
 
6. Systemic Hypertension
         The risk of coronary heart disease is directly related to blood pressure, for every drop of blood pressure by 5 mmHg disatolic coronary heart disease risk was reduced by about 16%. Increase in systemic blood pressure increases the resistance to the pumping of blood from the left ventricle, ventricular hypertrophy occurs as a result to increase the strength of contraction. By myocardial oxygen demand will increase due to ventricular hypertrophy, this resulted in an increase in the workload of the heart which in turn lead to angina and myocardial infarction. Besides, it is also simply say increased blood pressure accelerates atherosclerosis and arteriosclerosis, so that rupture and vascular occlusion occurred 20 years earlier than normotensive people. Framingham study showed LVH coronary heart disease will raise 4-5 times in patients with advanced age.

7. Hiperhomosistein
           Elevated levels of homocysteine in the blood of late has been established as an independent risk factor for the occurrence of thrombosis and vascular disease. Hyperhomocysteinemia This will further enhance further atherothrombotic vascular events in individuals with other risk factors such as smoking and hypertension.
         More than 31 case-control studies and cross-sectional involving approximately 7000 patients with hyperhomocysteinemia found in 30% to 90% of patients with atherosclerosis and is associated with increased risk of coronary heart disease.

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