The first step in planning an intervention for atherosclerosis is to assess the degree of risk for an atherosclerotic problem. The American Heart Association has developed criteria by which to judge the degree of risk.

The older classification system of the American Heart Association classifies risk factors into Major and Contributory. This system has been replaced by a newer, and to some a more cumbersome, classification system, but this older system is still in use.

MAJOR RISK FACTORS:

These are the risk factors known to be associated with a significant increase in heart disease and stroke. They are divided into those that are modifiable, and those that are not.

NON-MODIFIABLE:

Advanced age.

Male gender.

Heredity/Family History.

Race.

MODIFIABLE:

Smoking.

Elevated Cholesterol.

Elevated Blood Pressure.

Diabetes.

Physical Inactivity.

Obesity/Overweight.

CONTRIBUTORY RISK FACTORS:

These are risk factors that have been associated with an increased risk of heart disease, but the significance of that risk has not been determined yet.

Stress.

Elevated triglyceride.

More than moderate alcohol use.

Estrogen deficiency.

Syndrome X.

Syndrome X is used to describe a particular group of risk factors which seem to cluster in certain groups of people, and such people appear to be at an increased risk of heart disease and stroke. These characteristics include:

-Central Obesity.

-Glucose Intolerance.

-Hyperlipidemia, primarily high triglyceride and high LDL.

-High Blood Pressure.

The newer system of risk factors devised by the American Heart Association takes into account new evidence showing additional factors associated with heart disease. This gives a more detailed, but also more involved, array of risk factors to consider. They are grouped into four categories:

(1.) CAUSATIVE RISK FACTORS:

-Advanced Age.

-Smoking.

-Elevated Blood Pressure.

-Elevated Cholesterol or LDL.

-Diabetes.

-Elevated ApoLipoprotein B.

-Low LDL.

(2.) CONDITIONAL RISK FACTORS:

-These are called conditional because they are associated with an increased risk on the condition they are elevated:

-Elevated Triglyceride.

-Elevated Lipoprotein B.

-Elevated Homocysteine.

-Elevated Coagulation Factors.

-Elevations of:

-Fibrinogen.

-Plasminogen Activating Factor I.

-C-Reactive Protein.

(3.) PREDISPOSING FACTORS:

These factors contribute to the development of causal and conditional factors.

-Overweight/Obesity.

-Physical Inactivity.

-Male Gender.

-Family History of a premature cardiac event.

-Low Socioeconomic Status.

-Behavioral Factors such as Depression.

-Insulin Resistance.

(4.) EKG FINDINGS:

There are two EKG findings which, if present, are considered risk factors:

(1.)  Non-specific ST-T changes: This is considered to be a causative factor.

(2.)  Evidence of left Ventricular Hypertrophy: This is called a Susceptibility Factor.

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