Risk factors for coronary heart disease and family medicine – what can be done?
Abstract
Background / Aim: More people die each year due to cardiovascular diseases (CVDs) than from any other cause. The most common cause of ischaemic heart diseases (IHD) is atherosclerosis of the coronary arteries. Risk factors for the development of coronary heart disease (CHD) can be preventable and non-preventable. The aim of the study was to determine the frequency of individual risk factors in patients with CHD.
Methods: Retrospective analysis included patients with diagnoses of stable angina pectoris (AP), unstable angina pectoris and myocardial infarction - acute coronary syndrome (ACS) and ischaemic cardiomyopathy (iCMP). The prevalence of the following risk factors for IHD was analysed: hypertension, diabetes, obesity, cholesterol, smoking, family history, age and sex. Data were taken from the Register of Patients with Chronic Diseases and Risk Factors and electronic patient records.
Results: Of the total number of respondents older than 18, 4.95 % had CHD. Of the 178 patients with IHD, 70 (39.3 %) patients had AP, 60 (33.7 %) patients had ACS and 48 (27.0 %) patients had iCMP. Positive family history had 63.5 % of patients, 72 % were older than 66, 24.1 % were smokers and 74.2 % of patients had elevated blood cholesterol levels. Diabetes mellitus affected 29.2 % of patients, hypertension 88.8 %, and BMI ≥ 25 kg/m2 had 70.8 % of patients. Of the total number of patients with ACS, 68.3 % were men, while higher percentage of women suffered from AP (62.9 %) (p = 0.002). In the age below 65, CHD was more common in men (p = 0.007). Cholesterol was elevated more often in patients with AP than iCMP (p = 0.001). Patients with ACS were more likely to have diabetes mellitus compared to patients with AP and iCMP (p = 0.010).
Conclusion: The prevalence of preventable risk factors is alarmingly high. Of particular importance is the timely detection and treatment of risk factors by family physicians and strengthening the personal responsibility of each individual in choosing their lifestyle and active involvement in the therapeutic process.
References
1. Jensen RV, Hjortbak MV, Bøtker HE. Ischemic heart disease: an update. Semin Nucl Med 2020 May;50(3):195-207.
2. Maksimović ŽM, Banjac N, Čović M. Significance of dyspnoea as a symptom in the emergency department of the primary healthcare centre. Scr Med 2020;51(3):158-65.
3. Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Med 2013 May 1;11:117. doi: 10.1186/1741-7015-11-117.
4. WHO. Health topics: cardiovascular diseases [Internet]. Geneva. Available from: https://www.who.int/health-topics/cardiovascular-diseases/. [Cited: 2021-July-7].
5. Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in mortality from ischemic heart disease and cerebrovascular disease in Europe: 1980 to 2009. Circulation 2016;133(20):1916–26.
6. Kralj V, Brkić Biloš I. Morbidity and mortality from cardiovascular diseases. Cardiol Croat 2013;8(10-11):373-8.
7. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37(42):3232–45.
8. Mihajlović D, Maksimović ŽM, Dojčinović B, Banjac N. Acute coronary syndrome (STEMI, NSTEMI and unstable angina pectoris) and risk factors, similarities and differences. Scr Med 2020;51(4):252-60.
9. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Rev Esp Cardiol (Engl Ed) 2021 Jun;74(6):544. doi: 10.1016/j.rec.2021.05.002.
10. Lemic-Stojcevic N, Dundas R, Jenkins S, Rudd A, Wolfe C. Preventable risk factors for coronary heart disease and stroke amongst ethnic groups in London. Ethn Health 2001 May;6(2):87-94.
11. Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Li CP. High blood pressure and all-cause and cardiovascular disease mortalities in community-dwelling older adults. Medicine (Baltimore) 2015 Nov;94(47):e2160. doi: 10.1097/MD.0000000000002160.
12. Carbone S, Canada JM, Billingsley HE, Siddiqui MS, Elagizi A, Lavie CJ. Obesity paradox in cardiovascular disease: where do we stand? Vasc Health Risk Manag 2019 May 1;15:89-100.
13. Peters SA, Singhateh Y, Mackay D, Huxley RR, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis 2016 May;248:123-31.
14. Leon BM, Maddox TM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 2015 Oct 10;6(13):1246-58.
15. Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis 2020 Jul;12(7):3866-76.
16. Li J, Siegrist J. Physical activity and risk of cardiovascular disease - a meta-analysis of prospective cohort studies. Int J Environ Res Public Health 2012 Feb;9(2):391-407.
17. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J 2010 Dec;18(12):598-602.
18. Dhingra R, Vasan RS. Age as a risk factor. Med Clin North Am 2012 Jan;96(1):87-91.
19. Jokšić R, Cvetićanin B, Lekin I, Jokšić M. Chest pain: A significant guideline in the diagnosis of acute coronary syndrome. ABC 2011;11(1):12-7.
20. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2018 Jan 7;39(2):119-77.
21. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al; ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010 Oct;81(10):1219-76.
22. WHO. Consultation on Obesity [Internet]. Geneva; 1997. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight/. [Cited: 2021-July-7].
23. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012 Jul;33(13):1635-701.
24. Štrbac S, Pilipović Broćeta N, Todorović N, Vujić Aleksić V, Stević S, Lolić A, et al. Short-term training of family medicine teams on cardiovascular risk assessment and management - effects on practice and outcomes. Scr Med 2021 Sep;52(3):165-73.
25. Regitz-Zagrosek V, OerteltPrigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, et al; EUGenMed Cardiovascular Clinical Study Group. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2016;37(1):24–34.
26. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015 Jan 27;131(4):e29-322.
27. EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 2001 Apr;22(7):554-72.
28. EUROASPIRE I and II Group; European Action on Secondary Prevention by Intervention to Reduce Events. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention by Intervention to Reduce Events. Lancet 2001 Mar 31;357(9261):995-1001.
29. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al; European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007 Oct;28(19):2375-414.
30. Bergovec M, Reiner Ž, Miličić D, Vražić H. Differences in risk factors for coronary heart disease in patients from continental and Mediterranean regions of Croatia. Wien Klin Wochenschr 2008;120:684–92.
31. Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, et al; EUROASPIRE Investigators. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016 Apr;23(6):636-48.
32. EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 2001 Apr;22(7):554-72.
33. Vulić D, Krneta M, Lazarević A, Ciric Z. [Results of monitoring risk factors and therapeutic approach in a study of monitoring coronary patients in the Republic of Srpska (ROSCOPS I i II)]. Balneoklimatologija 2005;29(1):385-9. Serbian.
34. Vulić D, Krneta M, Šobot M. [Guidelines of secondary prevention coronary artery disease prevention]. Srce i krvni sudovi 2011;30(4):241-5. Serbian.
35. Scottish Intercollegiate Guidelines Network (SIGN) [Internet]. Acute coronary syndromes. Edinburgh: SIGN; 2013. [Cited: 2020-July-7]. Available from: http://www.sign.ac.uk.
36. Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999 Sep 28;100(13):1481-92.
37. Villablanca AC, McDonald JM, Rutledge JC. Smoking and cardiovascular disease. Clin Chest Med 2000 Mar;21(1):159-72.
38. Richardson PJ, Hill LS. Relationship between hypertension and angina pectoris. Br J Clin Pharmacol 1979;7 Suppl 2(Suppl 2):249S-253S. doi: 10.1111/j.1365-2125.1979.tb04697.x.
39. Gidding SS, Allen NB. Cholesterol and atherosclerotic cardiovascular disease: a lifelong problem. J Am Heart Assoc 2019 Jun 4;8(11):e012924. doi: 10.1161/JAHA.119.012924.
40. Howard BV, Robbins DC, Sievers ML, Lee ET, Rhoades D, Devereux RB, et al. LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL: The Strong Heart Study. Arterioscler Thromb Vasc Biol 2000 Mar;20(3):830-5.
41. Ličina M, Potpara T, Polovina M, Ostojić M, Milić N, Giga V, et al. [Regulation of risk factors in patients with ischemic heart disease treated with percutaneous coronary intervention]. Srce i krvni sudovi 2011;11(1):257-63. Serbian.
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