7. Epidemiology, risk factors and primary prevention of ischemic heart disease

Definition

Ischaemic heart disease (IHD) is an umbrella term for all conditions characterised by ischaemia of the myocardium. Because this is almost always due to coronary artery atherosclerosis, the term coronary artery disease (CAD) is virtually equivalent to IHD and they’re often used interchangeably.

We can distinguish acute and chronic ischaemic heart disease. Acute ischaemic heart disease is referred to as acute coronary syndrome (ACS). Chronic ischaemic heart disease is referred to as chronic coronary syndrome (CCS) or stable ischaemic heart disease.

Epidemiology

See here.

Risk factors

Classic risk factors:

  • Male gender
  • Older age
  • High total or LDL cholesterol
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • Family history
  • Obesity
  • Diet high in energy, low in vegetables, high in meat, high in fats, etc.

Non-classic (“new”) risk factors:

  • Metabolic syndrome
  • High inflammatory parameters (high CRP)
  • Abnormal blood coagulation parameters
  • Chronic renal disease
  • Oxidative stress, air pollution
  • Low socioeconomic status
  • Mental ill health, psychological stress
  • Alcohol abuse
  • Hyperhomocysteinaemia

Primary prevention

Screening asymptomatic healthy adults > 40 years with a risk-estimation system like SCORE is recommended. Healthy adults with first-degree relatives with premature (occurring earlier than normal) cardiovascular disease should also be screened.

Primary prevention involves reducing risk factors. See also here.


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8. The syndromes of ischemic heart disease and their differential diagnostics

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