Cardiac risk assessment

Identifying patients at risk for future cardiovascular events is important to ensure that they have access to optimal risk reduction treatments. The classical risk factors of family history, smoking status, hypertension, diabetes and LDL cholesterol levels remain important. HDL cholesterol is not necessarily protective against coronary disease whilst there is increased interest in lipoprotein (a) as a marker of risk and a potential therapeutic target.

Inflammation plays a key role in the pathogenesis of cardiovascular disease. Inflammatory disorders such as rheumatoid arthritis are associated with twice the risk of coronary disease. Radiotherapy to the chest particularly in the treatment of Hodgkins lymphoma and left sided breast cancer carries a significantly increased risk.

For women, pregnancy adverse events including pre-eclampsia, gestational hypertension, gestational diabetes and intrauterine growth restriction increase the risk for cardiovascular disease as do polycystic ovaries and endometriosis.

Calcium scoring is the biggest predictor of cardiac events.  

A healthy lifestyle with regular exercise, not smoking and a Mediterranean diet confer additional protection.

All risk should be interpreted in the context of ethnicity particularly for Māori, Pacifica and Indian patients.