In the news: Identifying New Risk Factors for CVD

Newly Identified CVD Risk Factors

Eye care professionals have a two-way relationship with cardiovascular health. Eye exams can reveal potential signs of cardiovascular disease (CVD) such as vascular changes in retinal vessels due to hypertension, development of cholesterol around the eyes with hypercholesterolemia, or temporary vision loss due to a transient ischemic attack.

At the same time, CVD may influence ocular health. For example, stroke can lead to distorted or lost vision, and evidence suggests that CVD may increase the risk of retinal artery occlusion and vision loss due to age-related macular degeneration.

Familiar, widely studied CVD risk factors include obesity, smoking, sedentary lifestyle, diabetes, high cholesterol levels and high blood pressure. But despite efforts to prevent and treat these risk factors, the mortality and burden of disease attributed to CVD remains high.

New coronary risk factors have emerged in recent years because of gaps that remain in assessing and treating CVD. An editorial(1) published in The American Journal of Medicine identifies and discusses the role of the new risk factors – a few of which are unusual, some that are not fully understood.

According to the author, recognizing the presence of one or more of these newly identified risk factors could trigger attempts by clinicians to minimize more traditional major risk factors.” Some of the newer risk factors include:

Systemic Inflammation

Several diseases characterized by systemic inflammation are among the new risk factors: •     Gout – having a recent flare of gout increases the risk of an acute CV event such as heart attack or stroke •     Rheumatoid arthritis, systemic lupus erythematosus, or both show higher odds for premature coronary artery disease (CAD) •     Inflammatory bowel disease (Crohn’s, ulcerative colitis) increases the chance for developing CAD •     Psoriasis patients are up to 50% more likely to develop CVD

Environmental Factors

An increased incidence of CAD has been related to two environmental factors that may themselves be connected: •     Low socioeconomic status characterized by increased psychosocial stress and limited educational and economic opportunities may be causative factors in enhanced CAD •     Air pollution, estimated to have caused 9 million deaths in 2019 worldwide, 62% due to CVD (CAD= 31.7% and stroke = 27.7%). Transient exposure to a variety of pollutants may trigger the onset of an acute coronary syndrome

Lifestyle Factors

•      Long working hours by those who have had a first heart attack raises the risk for a recurrent event (likely due work stressors). •     Skipping breakfast has been linked to increased cardiovascular and all-cause mortality. •     Prolonged intake of sugary and artificially sweet-ened drinks containing sugar is also associated with increased CV mortality.

Maternal and Childhood Factors

•      These maternal and childhood factors raise the risk of developing CAD: gestational diabetes, pre-eclampsia, delivering a child of low birth weight, preterm delivery, and premature or surgical menopause. How each condition is linked to higher CAD risk isn’t known, but may be due to increased cytokine and oxidative stress. •     A yet unexplained association has been observed between migraine headaches with aura in women and incident CVD •     Transgender patients receiving gender-affirming care are at increased CV risk, perhaps related to high rates of depression and anxiety •     Early life trauma and the risk of adverse CV outcomes in the young and middle-aged with a history of heart attack is also of interest

References

1. Alpert JS, Editor in Chief. New coronary heart disease risk factors. Am J Med. 136:331-332, April 2023.