Risk factors of cad
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Risk Factors of Coronary Artery Disease (CAD)
Genetic Risk Factors for CAD
Genetic predisposition plays a significant role in the development of coronary artery disease (CAD). Genome-wide association studies have identified numerous genetic variants associated with increased CAD risk. For instance, a genomic risk score (metaGRS) consisting of 1.7 million genetic variants has been shown to predict CAD outcomes effectively. Individuals in the top 20% of the metaGRS distribution have a hazard ratio (HR) of 4.17 for CAD compared to those in the bottom 20%. Additionally, specific polymorphisms, such as the GP IIIa PI(A1/A2) genotype and the TT homozygous variant of MTHFR, have been linked to increased CAD risk. Chromosome 9p21.3 has also been associated with the premature onset of CAD.
Lifestyle and Environmental Risk Factors
Lifestyle choices and environmental factors are critical contributors to CAD. Smoking, hypertension, diabetes, hyperlipidemia, and obesity are well-established risk factors . Smoking, in particular, is highly prevalent among individuals with premature CAD, with 60.8% of such patients having a history of smoking. Psychosocial stress and depression are also significant risk factors, with depression conferring a relative risk between 1.5 and 2.0 for the onset of CAD in healthy individuals.
Socioeconomic and Demographic Factors
Socioeconomic status and demographic factors, such as education and early life influences, contribute to CAD risk. South Asians, for example, have a higher risk for CAD due to a combination of conventional risk factors and unique conditioning factors like socioeconomic status and fetal programming. In China, traditional cardiovascular risk factors such as hypertension, diabetes, and smoking are poorly managed, especially in rural areas, leading to a higher prevalence of CAD.
Comorbid Conditions
Comorbid conditions, including chronic inflammatory diseases and chronic kidney disease, are associated with recurrent major adverse cardiovascular events (MACEs) in CAD patients. Additionally, there is a notable interrelation between CAD and cancer, with cancer patients having a higher prevalence of CAD and vice versa.
Biochemical and Coagulation Factors
Biochemical factors, such as elevated low-density lipoprotein (LDL) cholesterol levels, are strongly associated with CAD. Higher LDL cholesterol values significantly increase the risk of CAD. Coagulation factors also play a role, with certain genotypes like the factor VII R353Q being correlated with a reduced risk for cardiovascular diseases.
Conclusion
Coronary artery disease is influenced by a complex interplay of genetic, lifestyle, environmental, socioeconomic, and comorbid factors. Effective management and prevention strategies must consider these diverse risk factors to reduce the global burden of CAD. Early genomic screening, lifestyle modifications, and targeted therapies could significantly improve outcomes for individuals at high risk.
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