Risk factors cardiovascular

A Risk factor corresponds in a state Physiologique, Pathologique or a practice of life correlated with a increased Incidence of a Maladie.

Risk factors cardiovascular is a used short cut to speak about the risk factors of the Athérome.

The athérome consists of the attack of the Artère S, involving their contracting and being able to lead to their occlusion. This arterial disease is responsible:

of the Angina pectoris or the Myocardial infarction if it reaches the coronary arteries
of the cerebral vascular accidents if it reaches the arteries with encephalic destiny
of an obliterating Artériopathie of the lower extremities in the event of attack of the arteries of the lower extremities.

Risk factors

They were found at the time of epidemiological studies prospective: a population whose initial characteristics are known is followed médicalement during many years. The correlations enters occurred of vascular accidents and some of these initial characteristics can be then analyzed statistically.

Most known of these studies remains that of Framingham, small town American where the whole of the adult population (nearly 5000 people) was followed médicalement during more than 20 years.

These risk factors thus make it possible to calculate the probability that has an individual to have an vascular accident within a given time. Scores of risk are thus available, making it possible to determine whether a person is with high-risk or low risk, which allows an adapted strategy, different according to the level from risk.

In any rigor, the catch of actions making it possible to reduce a risk factor does not mean obligatorily that one decreases the vascular risk. Indeed, the risk factor in question can be simply a marker not intervening at all in the genesis of the athérome. It is then necessary to prove the effectiveness of these actions through interventionnelles studies showing the correlation between the effectiveness of these actions on the risk and the reduction in the vascular accidents.

These interventionnelles studies were undertaken with a certain success on the risk factors " classiques" (Diabetes, Nicotinism, HTA, Dyslipidémie). They remain to be made, in particular on certain biological markers of the vascular risk.

Irreversible factors

age (the risk increases with the age);
sex (male or in the event of early Menopause at the woman);
genetic factors (Heredity);

Avoidable or curable factors

arterial Hypertension;
standard Diabetes of the type 1 or 2;
Nicotinism;
Dyslipidémie S: inter alia the excess of Cholesterol in blood (Hypercholestérolémie), and especially the " mauvais" cholesterol (LDL) by excess of consumption of saturated greases or unsaturated greases '' trans ''. The increase in the Triglycéride S is also a recognized risk factor of the cardiovascular diseases but its independent character (a patient having a triglyceride high rate is very often obese, diabetic…) is not attested.
overweight, Obesity.

Or not proven nonindependent factors

The following risk factors are suspect, without one having an formal evidence of it, primarily because of a difficulty of quantification and definition:

Sedentariness;
Stress;

The following risk factor is known as dependant , because its presence is correlated with the other already quoted risk factors:

Hyperuricémie .

Risk factors in the course of evaluation

The following risk factors were recently given but their precise place remains to be determined (dependant or independent). There is not, in particular, little or not studies directly proving an effectiveness of the reduction of these risk factors in the vascular disease:

increase in the Protéine C reactivates;
increase in BNP;
increase in the Fibrinogen;
increase in the Homocystéine;
Atmospheric pollution by fine particles.

Medical prevention and assumption of responsibility

The prevention of the cardiovascular diseases starts very young person, thanks to a regular physical exercise and a balanced food, diversified, for example by a food practice nearest possible to the Régime crétois.

To have a personalized diagnosis, it also passes by a Dépistage realized by a doctor (by a interrogation, a Clinical examination complete and a blood sample).

Prevention (primary in particular): to adopt simple behaviors

The primary prevention gathers all that makes it possible to avoid the cardiovascular incidents or accidents (like Infarctus or Cerebral vascular accident) at a person not having never had these diseases. The secondary prevention gathers what it is advisable to do to avoid a repetition, or an aggravation of such an incident or cardiovascular accident when he occurs.

The distinction is not only academic: the risk of new accident is much greater at a person having made a first vascular accident. The prevention must be then particularly rigorous about it.

The disease risks coronary can be reduced by adopting simple behaviors:

regular physical exercise and obviously adapted to the person, of type goes, bicycle or swimming (for example 3 one hour weekly sessions)
correction of a overweight or actions on a obesity
stop of the tobacco (the incidence of IDM decreases) and fights against the Passive smoking: 2/3 of the 5.000 annual deaths in France related to passive smoking are of origin cardiovascular.
reduction in the contribution in double salt, often or triple of the maximum recommended. See the example of Finland, where a reduction from 30 to 35% of the salt contributions, during the 30 last years, largely contributed to the fall of 75% of the cardiovascular Mortalité at less than 65 years. Mainly thanks to a fall of more than 1 point of the blood pressure average of the population. " Salt less, you will live lighter and longer ".
practical food…

low in saturated greases and supporting the vegetable fats nonhydrogenated (of first cold pressure)
low in greases trans characteristic of the industrial food (oils hot in a hurry, solid margarines, produced pastry making, pizza pies, cookies, etc)

while directing itself towards a food of the Mediterranean type (Mode crétois):

low in Meat red (except a little sheep and goat meat) and dairy products (except fresh cheeses or Yoghourt S)
rich in Poisson (especially fatty fish: sardine, mackerel), Vegetable S and Fruit dry S fresh, fruits, Cereal S (energy contribution bases), in particular the not refined Céréale S rich in food Fiber S, Légumineuse S, Olive oil, fatty-acids Omega-3

Medical assumption of responsibility

The risk factors can be decreased in the event of failure of measurements quoted above, or if it is necessary in a drastic way to act on these risk factors (for example after a heart disease):

medicamentous treatment of a Hypercholestérolémie in the event of failure of the food mode only;
treatment of a arterial Hypertension (reduction in the incidence of the AVC, action not proven within the framework of the infarction (IDM)) ;
balance glycemic optimal;
antiagrégants plate S in secondary prevention.

Not to forget:

that it is Médicament S, therefore not deprived of side effects, especially if they are taken with life: " Plus half of the patients who begin a anticholestérol treatment did not test as a preliminary a mode low in greases. However these drugs, taken with life, present risks of muscular attacks " according to the French Reciprocity.

and that these drugs can also interact with other drugs.

Limits of the prevention

The effectiveness of a precautionary measure must be evaluated: it must not only act in the good sense with respect to the risk factor aimed (blood-pressure, lipid…) but also to prove its effectiveness in the reduction of the number of cardiovascular accidents in the long run. For example, certain drugs with an effectiveness shown on cholesterol however did not show that they bring a fall in term of occurred of cardiovascular diseases.

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