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Risk factors
By Mayo Clinic staffRisk factors for coronary artery disease include:
- Age. Simply getting older increases your risk of damaged and narrowed arteries.
- Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
- Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55, or your mother or a sister developed it before age 65.
- Smoking. Nicotine constricts your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. The incidence of heart attack in women who smoke at least 20 cigarettes a day is six times that of women who've never smoked. For men who smoke, the incidence is triple that of nonsmokers.
- High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.
- High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as "good" cholesterol, also can promote atherosclerosis.
- Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Both conditions share similar risk factors, such as obesity and high blood pressure.
- Obesity. Excess weight typically worsens other risk factors.
- Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.
- High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease.
Risk factors often occur in clusters and may build on one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an ever greater risk of coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist — increases the risk of coronary artery disease.
Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including:
- Sleep apnea. This disorder causes you to repeatedly stop and start breathing while you're sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system, possibly leading to coronary artery disease.
- C-reactive protein. C-reactive protein (CRP) is a normal protein that appears in higher amounts when there's swelling somewhere in your body. High CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, you'll have more CRP in your blood.
- Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But excessive levels of homocysteine may increase your risk of coronary artery disease and other cardiovascular CRP conditions.
- Fibrinogen. Fibrinogen is a protein in your blood that plays a central role in blood clotting. But too much may increase clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis.
- Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) particle attaches to a specific protein. Lipoprotein (a) may disrupt your body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.
References
- Coronary artery disease. National Lung, Heart, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html. Accessed April 29, 2010.
- Morrow DA, et al. Chronic coronary artery disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50057-1&uniq=198193047&isbn=978-1-4160-4106-1&sid=989729689. Accessed April 29, 2010.
- Toth PP, et al. Coronary artery disease. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/198193047-17/0/1481/455.html#4-u1.0-B978-1-4160-2467-5..50041-5--cesec46_2228. Accessed April 29, 2010.
- Hall SL, et al. Secondary prevention of coronary artery disease. American Family Physician. 2010;81:289.
- Wilson PWF. Overview of the risk factors for cardiovascular disease. http://www.uptodate.com/home/index.html. Accessed April 29, 2010.
- Body composition tests. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4489. Accessed April 29, 2010.
- Heart disease. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/heart-disease/. Accessed April 29, 2010.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. May 7, 2010.
- Lovett E, et al. Advising patients about herbs and nutraceuticals: Tips for primary care providers. Primary Care: Clinics in Office Practice. 2010;37:13.
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