Coronary Artery Disease And Its Risk Factors

Coronary heart disease is the commonest cause of heart failure in Western countries. In the studies of left ventricular dysfunction (SOLVD) coronary artery disease accounted for almost 75% of the cases of chronic heart failure in male white patients, although in the Framingham heart study, coronary heart disease accounted for only 46% of cases of heart failure inmen and 27% of chronic heart failure cases in women. Coronary artery disease and hypertension (either alone or in combination) were implicated as the cause in over 90% of cases of heart failure in the Framingham study. Recent studies that have allocated aetiology on the basis of non invasive investigations—such as the Hillingdon heart failure study—have identified coronary artery disease as the primary aetiology in 36% of cases of heart failure. In the Hillingdon study, however, researchers were not able to identify the primary aetiology in 34% of cases; this methodological failing has been addressed in the current Bromley heart failure study, which uses coronary angiography as well as historical and non invasive findings.

Coronary risk factors, such as smoking and diabetes mellitus, are also risk markers of the development of heart failure. Smoking is an independent and strong risk factor for the development of heart failure in men, although the findings in women are less consistent. In the prevention arm of SOLVD diabetes was an independent risk factor (about twofold) for mortality, the development of heart failure, and admission to hospital for heart failure, whereas in the Framingham study diabetes and left ventricular hypertrophy were the most significant risk markers of the development of heart failure. Body weight and a high ratio of total cholesterol concentration to high density lipoprotein cholesterol concentration are also independent risk factors for heart failure. Clearly, these risk factors may increase the risks of heart failure through their effects on coronary artery disease, although diabetes alone may induce important structural and functional changes in the myocardium, which further increase the risk of heart failure.
(Source: ABC of Heart Failure)