Risk factors of Ischaemic Heart Disease

The chance of suffering an infarction increases with age. This increment is significant in men over 45 years and women over 55. This difference in age-related risk between men and women is due to the favourable influence of female hormones (oestrogens) on blood vessels.

Genetics. A family history of angina pectoris or infarction (heart attack) can imply a genetic predisposition. If your family background includes men under 55 or women less than 65 years old who have suffered an infarction, then this should be taken into account. If a family member has experienced an infarction at an older age it is most likely due to normal ageing rather than a genetic component. Although family disease parameters or indicators are also taken into account.

Smoking. Smoking is the biggest avoidable cause of disease, disability and death worldwide. It is associated with both heart and lung disease as well as various types of cancer. Smoking increases the risk of major cardiovascular events (e.g. infarction, stroke or death) by 25% in women and there is currently a growing tendency to smoke among young women in our society. Abstinence from smoking is associated with a reduction in the risk of infarction and death; inclusion in smoking cessation programmes have shown to be effective in helping individuals successfully stop smoking and improve their overall health.

High Blood Pressure. This is a continuous or sustained elevation in blood pressure. High blood pressure causes damage to the walls of the arteries and can accelerate the process of atherosclerosis. There is a higher prevalence of hypertension in women over 60 than in men, and blood pressure is known to be less controlled in women and a significant risk factor for stroke. Blood pressure should be kept to below 140/90 mmHg. This can be achieved avoiding excess sodium in the diet, exercising regularly and properly following treatment to reduce blood pressure. 

Hypercholesterolemia. You should monitor the fat levels in your blood using analytical tests. Elevated LDL cholesterol (“bad” cholesterol) or triglyceride levels have been linked to a greater risk of coronary disease. However, a high HDL cholesterol level (“good” cholesterol) offers protection against an infarction. A healthy diet and regular exercise are excellent ways of increasing the amount of “good” cholesterol. The current objective for patients who have suffered a cardiovascular event is to reduce LDL to below 55 mg/dl and baseline levels by more than 50%.

Diabetes. The increase in blood sugar (glucose) levels has been linked to a higher risk of heart attack. It is important to maintain good blood sugar control, either through oral medication or insulin.

Patients with a cardiac event and diabetes mellitus (DM) may more frequently present with nonspecific symptoms, which can lead to delays in diagnosis and access to treatment. Although the prevalence of diabetes is similar in both sexes, there is evidence of a higher risk of ischaemic heart disease among diabetic women (40–50% higher risk) compared to men.

Losing weight, following a healthy diet, and exercising regularly can greatly help control blood sugar levels.

Sedentary lifestyle. Sedentary behaviour is associated with increased obesity, high blood pressure, and poorer control of diabetes and cholesterol. Regular physical activity offers many benefits in managing these risk factors. It is recommended to engage in progressive physical activity for 30–60 minutes at least twice a week.

Hormonal factors. Hormonal imbalance plays a highly significant role in the risk of coronary heart disease for women. For example, during fertility, there are gynaecological problems such as polycystic ovary syndrome and ovarian insufficiency that entail an oestrogen deficit. Around 10% of the female population has polycystic ovary syndrome. These imbalances entail greater risk of metabolic syndrome and cardiovascular disease. Other disorders such as endometriosis, involve higher oestrogen levels which, in turn, can increase risk. Although menopause cannot be considered as a risk factor as such, it is true that it marks a biological transition in women, producing a greater risk of cardiovascular disease due to the loss of the protective effect of oestrogen.

Obesity. Being overweight is increasingly common in today’s society and worsens the other risk factors. Even losing just a little weight can be very beneficial for the cardiovascular system. Depending on the location of excess fat, there are two types of obesity: Peripheral (excess fat located in buttocks, thighs and arms) and Central (excess fat concentrated in the abdomen). Excess abdominal fat can double the risk of cardiovascular disease. Central obesity is more common among women than men, particularly affecting those after the menopause.

Metabolic syndrome. This is a set of interrelated risk factors (central obesity, high blood pressure and hypercholesterolaemia) that lead to an inflammatory, thrombotic state, as well as greater insulin resistance (which may lead to diabetes), increasing cardiovascular morbidity and mortality. The prevalence of metabolic syndrome among middle-aged women is 20-30% with a marked increase after menopause.

Drugs and other toxic substances. Some drugs, e.g., cocaine or amphetamines, can modify how the arteries work and cause a vascular spasm; the artery contracts and stops the blood flow. Cocaine consumption is a relatively common cause of heart attacks, especially in the younger population.

Stress or depression. Stress, whether acute or sustained over time, can initiate hormonal and inflammatory mechanisms that can damage the arteries in the long term. A highly stressful event can trigger a heart attack, more frequently in women (90% of cases), even in the absence of coronary atherosclerosis. This is known as Takotsubo cardiomyopathy or broken heart syndrome.

Together with stress, depression is an increasingly prevalent and recognised risk factor for cardiovascular disease. There is also evidence that women have a higher prevalence of depression and stress, as well as less family and emotional support, than men after a heart attack. Depression and stress lead to a lower quality of life, especially for women. 

Pre-eclampsia or other non-traditional risk factors or diseases. Hypertensive disorders during pregnancy or gestational diabetes are related to an increase in future cardiovascular risk. 

Chronic inflammatory and autoimmune diseases (e.g. rheumatoid arthritis and systemic lupus erythematosus) are more prevalent in women and are associated with endothelial dysfunction, accelerated atherosclerosis and an increase in the risk of suffering a heart attack. Some cancer treatments can become cardiotoxic; hence the importance of a cardiovascular risk evaluation before, during and after treatment. 

Environmental factors. Air pollution increases the risk of coronary heart disease, heart failure, arrhythmias, cerebrovascular disease and pulmonary thromboembolism. Legislative measures and environmental strategies are necessary to reduce the effects of climate change in health, as well as promote green spaces.