Cholesterol
Cardiovascular risk factors
Evidence has shown that an individual patient’s risk of developing cardiovascular disease is considerably increased by additional risk factors. These can either be modifiable factors such as diet, smoking and physical inactivity, or un-modifiable factors such as age, gender or family history. Of these, three factors are considered to be of prime importance:1
- Smoking is responsible for 50% of all avoidable deaths, of which half are due to cardiovascular disease (CVD)
- Raised blood pressure is an important risk factor in the development of CVD – The greater the increase in blood pressure, the higher the risk
- Dyslipidaemia, in particular elevated LDL-C levels, is associated with an increased risk of CVD
Multiple risk factors:
Individual patients usually display multiple cardiovascular risk factors – a single risk factor rarely occurs in isolation. When risk factors co-exist, their combined effect is greater than the sum of their individual effects.2
Metabolic syndrome:
Multiple risk factors are associated with metabolic syndrome, which is characterised by dyslipidaemia, hypertension, insulin resistance, visceral distribution of body fat, and a prothrombotic state.3 All these components are associated with endothelial injury and dysfunction, the primary event that results in atherosclerosis.3
Obesity:
Obesity, especially abdominal obesity, represents a strong independent risk factor for CVD and is associated with metabolic syndrome. The multiple risk factors that characterise metabolic syndrome tend to cluster in abdominally obese individuals.4,5
Diabetes:
Type 2 diabetes is an independent risk factor for CVD. Individuals with Type 2 diabetes have twice the risk of CVD-related death than those without, irrespective of other known risk factors.6
Previous clinical events:
Patients with established CVD and those who have experienced a previous cardiovascular event are at a greater risk of subsequent events than individuals who remain asymptomatic.7
It has been found that the greatest benefits of cholesterol lowering are seen in individuals at the highest cardiovascular risk. Even modest cholesterol reductions produce substantial benefits in patients with multiple risk factors.
References:
1. Wood D et al, for the Joint European Committee, Second Task Force of European and other Societies. Atherosclerosis 1998; 140: 199-270.
2. Kannel MD et al. Am Heart J 1986; 112(4); 825-836.
3. Deedwania PC. Am J Med 1998; 105(1A); 1S-3S.
4. World Health Organization. The World Health Report 2002.
5. International Cardiovascular Disease Statistics 2005; American Heart Association.
6. Almdal T et al. Arch Intern Med 2004 ; 164(13): 1422-1426.
7. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehab 2007; 14: E1-E40.