What are the factors that increase the risk of atherothrombotic disease?

Numerous factors are associated with an increased risk of atherothrombotic disease. Traditional risk factors include:1

  • Elevated cholesterol
  • Hypertension
  • Smoking
  • Diabetes
  • Male gender
  • Increasing age

These traditional risk factors are included in all guideline-recommended risk calculators used to estimate cardiovascular (CV) risk in patients without documented CV disease (such as the SCORE system recommended by the European Society of Cardiology [ESC], the pooled cohort studies equation recommended by the American College of Cardiology/American Heart Association [ACC/AHA] and QRISK1/2 recommended by the UK National Institute for Health and Care Excellence [NICE]).2

More recently, several additional factors have been associated with an increased risk of CV disease. These include:2,3

  • A family history of early onset CV disease
  • Moderate or severe chronic kidney disease
  • Psychosocial risk factors (such as low socioeconomic status, depression and stress)
  • Inflammatory and autoimmune disease (such as rheumatoid arthritis and systemic lupus erythematosus)
  • Erectile dysfunction in men

Many of these factors are included in the most recent version of the QRISK estimator – QRISK 3.3

Although atherosclerosis is a systemic disease with overlapping risk factors, the relative importance of different risk factors appears to be subtly different in patients with different manifestations of the disease. One study showed that the leading risk factors for myocardial infarction (MI) were dyslipidemia, current smoking and psychosocial factors,4 whereas for peripheral artery disease (PAD), smoking, diabetes and hypertension appear most important.5 Modifying these risk factors, both through lifestyle modifications and medication targeted at controlling cholesterol, blood pressure and diabetes, is a cornerstone of prevention in patients with atherosclerotic disease.2,6,7


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