Sex: M>F, Uncommon in women of child bearing age (unless other strong risk factors are present). The difference equals out by about age 60 – 70. Estrogen replacement may offer some protection if initiated in younger postmenopausal women, but in some studies postmenopausal estrogen replacement actually increased cardiovascular risk.
Genetics: There is a well-established genetic predisposition to atherosclerosis, probably polygenic & related to the genetics of the other risk factors; i.e. diabetes, hyperlipidemia, hypertension. Parents with no significant atherosclerotic disease well into old age may be your best protection.
The Big Risk Factors
Hyperlipemia (increased LDL and decreased HDL cholesterol)
Hypertension (blood pressure >130/80 mm Hg or on antihypertensive medication)
Note: Atherosclerosis may occur in the absence of any risk factors (i.e. half of heart attacks occur in persons with normal cholesterol), or some persons with risk factors may not have significant disease. Conclusions:
We don’t know everything about the disease.
Genetics is important!
The Metabolic Syndrome
Abdominal obesity (waist > 40 inches for men, > 35 inches for women)
Treatment involves “therapeutic lifestyle changes” – diet, weight reduction, increased physical activity (see ATP III study in JAMA 285:2485-97, 2001)
Look up your risk at http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
Note: This is not the only online medical app. There are now about 40,000 smartphone/tablet medical apps covering everything from everything from hypertension to depression, and these are largely as yet unregulated (Indpls. Star, 6/24/2012).
Suggests that inflammation plays a major role in the pathogenesis of AS
Diet, weight loss, cessation of smoking all lead to CRP
Statins, other cholesterol lowering drugs, and ASA all CRP
There is some evidence that the strength of CRP as an independent risk factor may have been overestimated; increased WBC may also serve as a marker for systemic inflammation and is a lot cheaper
Dr. Paul Ridker at of Harvard Medical School has received much attention in the lay press as well as academia in the last few years for his publications relating C-reactive protein to cardiovascular risk. See Ridker, et al., NEJM 347:1557, 2002, for an “original” paper, and Ridker, Circulation 107:363, 2003 for a brief review of the CRP topic. In an article in Fortune magazine in October 27, 2003, Ridker’s and others discuss ideas about “anti-aging” for the layman. A recent NEJM article on the “Jupiter” study provides evidence that a statin drug (Crestor) reduces the rate of cardiovascular problems in persons with CRP even if they have normal cholesterol (see The Wall Street Journal, November 10, 2008, for the business-oriented summary).
There are numerous other markers for AS risk. One recent one is cystatin (google it). This is a marker for renal function (somewhat like creatinine). It is known that patients with renal insufficiency are at higher risk for cardiovascular events. Even low birth weight as been associated with increased risk of AS in later life!