Chapter 8

### Cardiovascular (including coronary) risk factors

Cardiovascular disease includes coronary heart disease, cerebrovascular disease (causing strokes and transient ischaemic attacks) and peripheral vascular disease. The basic cause of most disorders is a build-up of atheroma (a fatty deposit) within the lining of arteries. These patches of atheroma can trigger a blood clot (thrombosis).

##### The problem of coronary heart disease

The number one cause of death in modern Western society is coronary heart disease (CHD), whether it be from sudden fatal heart attacks or blocked coronary arteries causing angina and heart failure. CHD is responsible for 1 in 3 deaths in Australia. However, there has been a very pleasing reduction in deaths from coronary heart disease and stroke in the past 20 years because people have made the effort to reduce their risk factors. In spite of this, it is still a major cause of preventable death and we still need to work hard at reducing the risk.

##### What are the risk factors?

• Hypertension (high blood pressure)

• Smoking

• High cholesterol

• Increasing age

• Diabetes

• Obesity

• Lack of exercise

• Stress

• Alcohol excess

• Family history

• Male gender

These risk factors increase the likelihood of development of hardening of the arteries (or atherosclerosis) due to atheroma; the benefit of reducing them is obvious. The factors are interrelated; for example excessive intake of alcohol will lead to hypertension.

Hypertension

The higher the blood pressure, the greater the risk. Regular checks, say yearly for people over 40 years, are advisable. Doctors recommend that you keep blood pressure at no more than 140 mmHg systolic (upper level) and 90 mmHg diastolic (lower level) for most of the time, though people with risk factors for cardiovascular disease should have blood pressure levels no higher than 130/80 mmHg.

Smoking

Cigarette smoking has been clearly shown to increase the risk of heart disease. The death rate from coronary heart disease is about 70% higher for smokers than for non-smokers and for very heavy smokers the risk is almost 200% higher. The more one smokes, the greater the risk.

It has also been proved that the incidence of heart disease falls in those who have given up smoking.

High cholesterol

It has been proved that high blood cholesterol is related to heart attacks. High cholesterol is caused by a diet high in saturated fats, as compared with polyunsaturated fats. It is recommended that every effort should be made to keep the total blood cholesterol level as low as possible and preferably below 4.5 mmol/L in adults with no risk factors. Ideally, the LDL (the ‘bad’ cholesterol) should be below 2.5 mmol/L and the ratio of total cholesterol to HDL (‘good’ cholesterol) should be below ...

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