Risk Factors for Atherosclerosis

1. Heredity: - ↑ed risk if close relative has AS before 65 years

2. Sex: - males have ↑ed risk (LDL:HDL ratio)

3. Age: - AS ↑es with age

1. Hyperlipidaemia:

• lipids transported in blood as lipoproteins
• HDLs (good guys)
• LDLs (bad guys) ratio important re AS
• liver secretes cholesterol as VLDLs

• ↑ HDLs → lower risk of MIs
• can be modified by exercise, diet, drugs

2. Smoking: (leading toxic public health hazard)

• possible hypoxaemia (Hb-CO) → EC injury
• nicotine → vasoconstriction → MI / EC injury
• ↑ platelet aggregation

3. Hypertension:

• EC damage ??
• can be modified by drug therapy / diet

4. Diabetes Mellitus:

• ↑ [glucose]plasma → glycosylation of LDLs → AS
• OR
• ↑ [glucose]plasma → oxidation of LDLs → AS

5. Obesity: only circumstantial evidence for link with CHD
6. Inactivity:
7. Personality: Type A / Type B controversy
8. Diet: - ↓ed risk in vegetarian communities (but other problems)

- ?? protection from red wine and fish oils (inhibit platelets)

e.g. Finland had 4x CHD cf. France, yet similar

fat/cholesterol diets

• butter ≡ saturated fats (FAs with single bonds)
• margarine ≡ unsaturated fats (FAs with double bonds)
• saturated FAs and cholesterol → ↑ plasma LDLs → plaque development
• eating unsaturated fats (veg. oils) → ↑ HDLs

• i.e. proteins important ⇒ genetic predisposition ??
• low rate of CHD in Mediterraneans
• ?? due to high intake of olive / veg. oils (linoleic acid)
• excellent at reducing LDLs
• fish oils also hypolipidaemic
• very low rates of CHD in Eskimos
• Japanese population 6 x less likely to develop CHD cf. USA

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