In China, with the improvement of people’s living standard and the gradual change of lifestyle, the incidence of coronary heart disease is increasing at an alarming rate and has become the first cause of death and disability in the population. Current research confirms that the occurrence of coronary heart disease depends on multiple risk factors, and in most cases on the synergistic effect of two or more risk factors. The interaction of multiple risk factors is much higher than the sum of individual risk factors. Currently, the risk factors for coronary heart disease are recognized to include male, age, family history of early onset coronary heart disease, smoking (current smoking >10 cigarettes/day), hypertension, hyperlipidemia, obesity, and a clear past history of cerebrovascular or peripheral vascular obstruction. Among them, hypertension, high cholesterol and smoking were considered to be the three most important risk factors for coronary heart disease. Except for gender, age and family history, all other risk factors can be prevented and treated. Adequate understanding and active control of the prevalence and changing trends of risk factors is of great importance to reduce the incidence of coronary heart disease and improve the quality of life.
1. Obesity
Due to the development of social and economic development, the change of diet structure, the development of transportation, more and more people are joining the ranks of obesity. In China’s developed areas, 35 to 59 years of age in the crowd of overweight people reached 50%. With the rise of body mass index, the probability that an individual has several risk factors rises accordingly. Some data show that the proportion of metabolic syndrome increases significantly in the obese group compared to the normal group, while obesity itself is one of the direct risk factors for coronary heart disease. Central obesity is currently considered to be the most dangerous. Therefore, weight control, reduce overweight and obesity is one of the important measures to prevent coronary heart disease .
2. Diabetes
Diabetes is not only an independent risk factor for coronary heart disease, but also the most important risk factor. A large number of epidemiological data at home and abroad prove that the prevalence of coronary heart disease in diabetic patients is much higher than that in non-diabetic patients, and the onset is early, the disease progresses rapidly, and the prognosis is poor. At the same time, the presence of lipid abnormalities, insulin resistance, hypertension, coagulation and fibrinolytic system abnormalities in diabetic patients can also increase the risk of other risk factors.
3. Smoking
Smoking is not only an independent risk factor for coronary heart disease, but also has additive and synergistic effects with other risk factors. The younger the age of smoking, the higher the relative risk of coronary heart disease. Smoking can increase the risk of coronary artery spasm by more than four times. Some studies have demonstrated that the risk of coronary heart disease in smokers after controlling blood pressure, blood lipids, and body mass index may be three times higher than in nonsmokers, and that stopping smoking can reduce the risk of coronary heart disease or peripheral vascular disease by half. Due to the recognition of the hazards of smoking, the smoking rate in Western countries since the 20th century has been greatly reduced, in the United States only 1/4 people often smoke, in China, the male population smoking rate is still as high as 60%, the road to quit smoking is still very long.
4, metabolic syndrome
The main clinical manifestations of the metabolic syndrome are obesity, especially central obesity, hypoglycemia / type 2 diabetes, abnormal lipid metabolism and hypertension. In recent years, some large-scale studies have found that metabolic syndrome is the most important risk factor for cardiovascular disease, which can increase the incidence of coronary heart disease and stroke by 3 times.
5. Hyperlipidemia
Coronary heart disease primary and secondary prevention studies agree that increased cholesterol is the causative factor of atherosclerosis and coronary heart disease, and the mortality rate of coronary heart disease is increasing with the increase of serum cholesterol, and the cholesterol level is more obvious above 5.2mmol/L. Effective lipid-lowering therapy can prevent the occurrence and development of atherosclerotic lesions and reduce the morbidity and mortality of coronary heart disease. Lipid-lowering therapy can significantly improve the natural course of coronary heart disease, and its significance is no less than that of coronary artery bypass grafting. Lipid-lowering therapy should be carried out under the guidance of physicians. In general, patients, mainly with statins, should control plasma LDL cholesterol less than 2.6 mmol/L (100 mg/dl), and if combined with diabetes, metabolic syndrome, also smoking, one of the acute coronary syndromes (such as acute heart attack, unstable angina), LDL cholesterol should be controlled less than 1.8 mmol/L ( 70 mg/dl). Low LDL cholesterol, less cardiac events.
6. Hypertension
Hypertension has been proven to be one of the risk factors for coronary heart disease. Hypertension increases the risk of coronary heart disease by at least 2 to 3 times. At the same time, antihypertensive treatment can also significantly reduce the morbidity and mortality of coronary heart disease.
7. Inflammatory factors
Recent studies have shown that many inflammatory mediators have a very important role in the occurrence and development of atherosclerosis, such as cytokines affecting the stability of atheromatous plaques. Studies have found that after excluding risk factors such as hypertension, smoking and hyperlipidemia, interleukin-1 and tumor necrosis factor are closely related to the risk of coronary heart disease. c-reactive protein levels are positively correlated with increased risk of cardiovascular events.
8. Homocysteine
The association between homocysteine and cardiovascular disease has attracted much attention since the mid-1980s. Homocysteine is a sulfur-containing amino acid whose levels correlate with dietary intake of folic acid, vitamin B 6 and vitamin B 12, and plasma levels. It has been suggested that homocysteine is independent of other risk factors in the development of coronary artery lesions and does not need to be mediated by other risk factors .
9.Other
The endothelial cell function and coagulation risk factors also play a role in the development of coronary artery disease.
Although with the rapid development of medical technology, new technologies such as thrombolytic therapy, coronary artery bypass, and coated stents can save the lives of more and more patients with coronary artery disease, this is, after all, a last resort. Some studies have shown that comprehensive control of controllable risk factors can prevent more than 80% of acute coronary events. Therefore, the occurrence of coronary heart disease can be effectively controlled through the joint efforts of the whole society, especially by raising the awareness of risk factors of coronary heart disease among high-risk groups, patients with coronary heart disease and their families.