A comprehensive analysis of the eight major risk factors for cardiovascular and cerebrovascular diseases.

What are other risk factors for cardiovascular and cerebrovascular diseases?

The occurrence of cardiovascular and cerebrovascular diseases is the result of the combined effects of multiple risk factors. Other risk factors that increase the risk of cardiovascular and cerebrovascular diseases include the following:

(1) Age and gender: Men > 55 years old, women > 65 years old: The incidence of cardiovascular and cerebrovascular diseases increases with age. For example, among residents aged 35-74 in Beijing, the incidence of coronary heart disease increases by 1-3 times and the incidence of stroke increases by 1-4 times for every 10-year increase in age. This is because the levels of most pathogenic factors increase with age. Although the rate of increase slows down with age, the absolute risk remains high due to the high incidence in the elderly.

Because female hormones have a certain protective effect, the age of onset for women is usually delayed by 10 years compared to men. After menopause, their risk of developing the disease is almost equal to that of men.

(2) Smoking: The dangers of smoking are well known. Besides increasing the risk of death from cancer (especially lung cancer) by 45%, smoking is also one of the important causes of cardiovascular and cerebrovascular diseases. Smoking can directly damage vascular endothelium, promoting platelet aggregation and thrombus formation. The consequences range from mild plaque formation to severe acute thrombosis. In major organs and large blood vessels, this can lead to serious adverse events such as myocardial infarction and cerebral infarction. A prospective study in China showed that smokers have a 2 times higher relative risk of coronary heart disease, a 1 times higher risk of ischemic stroke, and a 21% higher risk of overall mortality compared to non-smokers.

The combined effects of different risk factors on the cardiovascular system can be additive or even amplified. If smoking is accompanied by hypertension and high cholesterol, the incidence of coronary heart disease increases 9 to 12 times. For individuals with other risk factors, smoking may cause even greater harm to the cardiovascular system. Therefore, to minimize the risk of cardiovascular events, a comprehensive prevention and control strategy, including smoking cessation, must be adopted.

(3) Dyslipidemia: Blood lipids mainly include serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). Low-density lipoprotein cholesterol (LDL-C) is a risk factor for coronary heart disease and ischemic stroke. High-density lipoprotein cholesterol (HDL-C) is "good" cholesterol, a factor in preventing atherosclerosis, and is significantly negatively correlated with the incidence of coronary heart disease. Based on the results of long-term observational studies on the risk of atherosclerotic cardiovascular disease (ASCVD) in the Chinese population, and referring to the recommendations of several international lipid-related guidelines, the newly revised "Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults (2016 Revised Edition)" continues the concept of the "2007 Guidelines for Lipids in Chinese Adults": listing appropriate levels and dividing abnormal cut-off points for lipid components, namely: TC > 6.2 mmol/L (240 mg/dl) is hypercholesterolemia; TG > 2.3 mmol/L (200 mg/dl) is hypertriglyceridemia. The ideal LDL-C level was proposed to be <2.6 mmol/L (100 mg/dl), and the ideal non-HDL-C level to be <3.4 mmol/L (130 mg/dl).

(4) Overweight, obesity, and abdominal obesity: Overweight and obesity are among the causes of hypertension, and also independent risk factors for coronary heart disease and stroke.

BMI is now commonly used to measure weight, i.e., BMI = weight/height². A BMI ≥ 24 is considered overweight, and ≥ 28 is considered obese. If abdominal obesity is predominant, i.e., waist circumference ≥ 90 cm for men and ≥ 85 cm for women, it is considered abdominal obesity.

(5) Diabetes and insulin resistance: Diabetes is a clear risk factor for atherosclerotic diseases and also a risk factor for coronary heart disease. A 1994 survey of over 200,000 people showed that the prevalence of diabetes and impaired glucose tolerance in China was 2.5% and 3.2%, respectively, a threefold increase compared to 10 years prior. A 2002 survey also indicated that the prevalence of diabetes in people over 20 years old in large cities had increased by 39% compared to 1996. Diabetic patients had higher BMI, waist-to-hip ratio, and blood pressure levels than non-diabetic individuals.

Serious insulin levels are significantly correlated with many cardiovascular risk factors, such as high triglycerides, low HDL-C, overweight and obesity, high blood pressure, high serum cholesterol, and high uric acid. Studies have shown that the incidence of coronary heart disease in the diabetic group is more than 10 times higher than in those with normal glucose tolerance. Postprandial blood glucose concentration is positively correlated with the incidence of coronary heart disease.

(6) C-reactive protein: Many studies have shown that C-reactive protein is related to cardiovascular disease and can predict the occurrence of cardiovascular events, with a predictive ability as strong as LDL-C. C-reactive protein is also closely related to metabolic syndrome. The standard is high-sensitivity C-reactive protein ≥3 mg/L or C-reactive protein ≥10 mg/L.

(7) Lack of physical activity: Reduced physical activity leads to slower metabolism, resulting in unburned fat and calories, inevitably causing overweight/obesity and a series of other problems. Follow-up studies of farmers in the suburbs of Beijing and Guangzhou showed that farmers who switched to working in township enterprises or non-agricultural labor had significantly higher BMIs and significantly increased cardiovascular and other risk factors compared to those who continued fieldwork. Lack of physical activity can increase the risk of cardiovascular disease in hypertensive patients.

(8) Family history of early-onset cardiovascular and cerebrovascular diseases: A family history of early-onset cardiovascular and cerebrovascular diseases is defined as a first-degree relative (biological parents, siblings) whose age of onset of cardiovascular and cerebrovascular diseases is <50 years. Individuals with this history have a higher risk of developing cardiovascular and cerebrovascular diseases compared to those without. This is also considered a risk factor in risk stratification assessments.