1. The role of unknown risk factors in coronary heart disease
Dr . A.A. Rafighoust ,MD

2. The importance of traditional risk factors in predicting risk of cardiovascular disease (CVD) is well known.

3. Cholesterol screening, the most common test used to screen for CVD risk, is unable to identify approximately half of who will develop acute myocardial infarction

4. Not all individuals with coronary heart disease have traditional risk factors
Khot et al. JAMA 2003

5. Analysis of more than 120/000 pts with CAD shows:
15% of men,19% of women had no evidence of:
Hyperlipidemia
Hypertension
Diabetes
Smoking
And more than half had:
Only one of the general risk factor

6. Despite the importance of blood lipids:
50% of all Mis occur among individuals without overt hyperlipidemia

7. 77% of all future CVE occur among pts with LDL- C less than 160mg/dc; 46% in LDL-C less than 130mg

12. More precise risk assessment is essential to reduce risk for CVD

13. Uncommon Risk factors
For atherosclerosis .

14. Novel Risk Factors Hyperhomocysteinemia Infection and inflammation
Hemostatic and coagulation disorders
inactivity and obesity
Fast food restaurant abuse
Second hand smoke

15. Novel risk factors include inflammation

16. inflammation
Inflammation has been firmly established as pivotal for development of future cardiovascular events

17. inflammation play a central role, in not only the: Development Progression Of atherosclerosis

18. But also in the subsequent plaque:
Instability
Thrombosis
That result in the clinical manifestation of an:
ACS

19. Marker of Inflammation

20. C-reactive protein (CRP)
High-sensitive c-reactive protein (hsCRP) is the most widely studied inflammatory biomarker

21. it is a strong predictor of short and long term C
it is a strong predictor of short and long term C.V risk among: Healthy men and women Pts with prior coronary events

23. HOMOCYSTEIN

24. Mechanisme:
Remain uncertain but include
Endothelial dysfunction acceleration of LDL-C oxidation

25. Pro-atherogenic pro- thrombotic

27. Infection and Inflammation
Chlamydia pneumoniae
Helicobacter pylori
Cytomegalovirus
Herpes virus
Periodontal disease

29. Helicobacter pylori
Thought to be a potential factor in causing pathophysiology of atherosclerosis

30. A mechanism for chronic systemic inflammation from Gm (-) organisms
Periodontal Disease
A mechanism for chronic systemic inflammation from Gm (-) organisms
After adjustment for other SRF in one study, there is a significant increased ischemic stroke risk (RR 2.1) among those with periodontitis.

31. Advanced disease estimated prevalence: 15% yo >45% in >65 y.o. One study showed a significant ischemic stroke risk (RR 2.1) among those with periodontitis

32. Psoriasis and Risk of Coronary Artery Disease: Detection of Early Atherosclerosis
Eric H. Yang, MD, FACC
Assistant Professor of Medicine
Director of the Coronary Care Unit
Interventional Cardiology
University of North Carolina at Chapel Hill

33. Severe psoriasis is associated with an increased risk of CAD.
The risk is highest in younger patients.
Future studies are needed to determine if systemic therapy reduces this risk.

34. Other novel risk factors with the risk of recurrent CVD:
Lower serum albumin
Higher serum createnin

35. Serum albumin:
Albumin is a negative acute-phase reactant,so it may reflect the role of inflammation in recurrent CVD

36. Serum createnin: Was a strong prediction of all-cause mortality among Mi survivors In our studies: Those with createnin greater than or equal to 1.4 were at 66% higher risk for recurrent CVD than those with less than 1.4mg/d

42. Earthquake And Coronary Heart Disease