Risk Factors in Heart Diseases

Cardiovascular diseases continue to threaten life worldwide. Moreover, statistics show that these diseases increase the loss of life. The 2023 report of the World Heart Federation points out that deaths due to heart diseases have increased by 60 percent in the last 30 years. However, it is possible to reduce the risk by taking precautions. Experts say, "The risk of a person having a heart attack can be reduced with regular monitoring, treatment and lifestyle changes."
At this point, although factors such as age and family history are defined as unchangeable risk factors for heart diseases, it is of great importance to focus on modifiable risk factors.

Traditional and Non-Traditional Risk Factors in Heart Diseases

Cardiology Specialist Assoc. Prof. Dr. Ayça Türer CABBAR states that atherosclerotic cardiovascular risk factors were classified as "traditional" and "non-traditional" in a review published in 2023. According to this classification, traditional risk factors are listed as: obesity, hypertension, diabetes, hyperlipidemia, smoking & tobacco use, kidney diseases, male gender and age. Non-traditional risk factors are: HIV/HAART (use of very active antiretrovirals), lifestyle & diet, obesity and metabolic syndrome, recreational substance use, pregnancy-induced hypertension, diabetes and preeclampsia, inflammatory and autoimmune diseases, chronic infections, some genetic diseases. It is divided into subgroups as clotting defects, vascular anomalies, and cholesterol metabolism diseases. Some of these risk factors are listed as follows:

Traditional Risk Factors in Heart Diseases

• Family History

Family history is considered an important risk factor for heart diseases. If a person's first-degree relatives (mother, father, sibling) have heart disease at an early age (under 40), this person's risk of developing heart disease increases. Another factor may be that family members have similar living habits. However, in rare cases, genetic mutations that increase susceptibility to certain heart diseases can run in families. Such inherited heart diseases can cause certain heart diseases to run in families.

• Obesity and Overweight 

Being overweight or obesity stands out as a factor that increases the risk of heart diseases. Excess fatty tissue increases inflammation in the body, as well as increases blood pressure and can affect cholesterol levels. However, increasing the risk of developing type 2 diabetes poses a risk for heart diseases in itself. Sleep apnea, another problem caused by obesity, can cause respiratory arrest during sleep, causing oxygen deficiency and heart stress. Therefore, weight is considered to be a very effective factor for heart diseases, both directly and indirectly.

• Hypertension

The risk of high blood pressure, which is one of the most important factors in terms of heart disease risk, increases with age. Statistics show that it is responsible for half of the deaths due to heart diseases and stroke worldwide.
Blood pressure of 140/90 mmHg or above is defined as hypertension. If high blood pressure is not treated, over time, it can cause many heart diseases such as plaque formation in the vessels, heart muscle weakness, heart rhythm disorder, heart failure, heart valve diseases and stroke. Therefore, in order to control high blood pressure, in addition to regular health checks, it is necessary to maintain a healthy weight, quit smoking and live an active life. In terms of blood pressure control, it is also important to learn to self-control blood pressure at home and record it.

• High Cholesterol

Cholesterol, defined as blood fats, is considered an important substance for the body. Its presence at high levels can accelerate plaque formation in the arteries and increase the risk of developing heart diseases. Especially high levels of bad cholesterol (LDL) are among the most important causes of cardiovascular diseases such as atherosclerosis, aerosclerosis, stroke and peripheral artery disease due to plaque accumulation in the coronary arteries.

• Type 2 Diabetes

There is a strong relationship between type 2 diabetes and heart diseases. Diabetes significantly increases the risk of developing heart diseases and negatively affects heart health through many different mechanisms. Due to sudden increase in blood sugar, heart vessels can be damaged and plaque formation can accelerate. This situation poses a risk for heart attack, heart failure and other heart diseases. However, since diabetes also poses a risk for hypertension and high cholesterol, the risk of heart diseases increases significantly in people with diabetes.

• Smoking

Both active and passive smoking are among the most important factors causing cardiovascular diseases worldwide. According to statistics, nearly 3 million people die every year due to heart diseases caused by smoking. Moreover, not only smoking but also being exposed to cigarette smoke or even smoking one or two cigarettes a day is enough to create a risk. The good news at this point is; One year after quitting smoking, the risk decreases by 50 percent. After 15 years, the person's risk of heart disease reaches the same level as a non-smoker.

Non-Traditional Risk Factors in Heart Diseases

• Recreational Substance Use

In recreational drug use, the risk of developing atherosclerosis increases more than 9-fold with four or more polysubstance uses. It is stated that methamphetamine and cocaine cause an increase in atherosclerotic disease.
In cocaine users, increased secretion of some substances in the body can cause constriction and contraction in the vessels and increase blood pressure. This condition not only causes a heart attack by causing shrinkage in the vessel feeding the heart, but also increases the release of other substances and increases the risk of clotting.

• HIV ve HAART 

There is evidence that HIV and HAART predispose to atherosclerosis. HAART treatments may further increase the risk of disease. While the rate of acute MI in patients with HIV is 11.13/1000/year, this rate is 6.98 for those without the disease. Many mechanisms related to this process are focused on.

• Chemotherapy and Radiotherapy

Chemotherapy and radiotherapy are considered to be very common treatment methods today. Cancer cell spread and angiogenesis (new blood vessel formation) use many overlapping pathways. Since treatments used to stop the spread of cancer can disrupt angiogenesis, it can be adversely affected during treatment and contribute to the development or progression of atherosclerosis. Radiation can cause DNA damage, oxidative stress, premature cellular aging and cell death. These are all thought to contribute to the progression of atherosclerosis.

• Lifestyle and Nutrition

Physiological stressors such as depressive symptoms, disturbed sleep, loss of interest, and financial stress are associated with an increased risk of cardiovascular disorders. It is stated that Garshick and his colleagues investigated non-traditional risk factors and examined young-middle-aged (age 25-57) patients who were newly diagnosed with critical stenosis in the heart vessels. It is found that patients have higher personal and financial stress and lower functional capacities. It is noteworthy that the diets of the patient group, especially young patients, are different. It is observed that the consumption of sugary drinks is higher in the young group than in the middle-aged group, and the consumption of fruits, vegetables and fish is relatively less.

• Pregnancy

While the pregnancy process does goes uneventful, risks that occur in abnormal situations such as high blood pressure or high blood sugar require follow-up after pregnancy. Preeclampsia (pregnancy poisoning), a condition that occurs during pregnancy and after the 20th week of pregnancy, accompanied by high blood pressure and protein leakage in the urine, appears to have a permanent effect on the susceptibility to the development of atherosclerosis. It is noted that the risk of cardiovascular disease in those who have this problem is doubled compared to those whose blood pressure was normal during pregnancy.

• Infection ve Inflammation

Chronic infections that can cause atherosclerosis include: HIV, Chlamydia pneumoniae, Porphyromonas gingivalis and Helicobacter pylori.
Some of the infections caused by these factors are; It is stated that gum diseases, pneumonia and stomach ulcers are encountered very frequently.

• Autoimmune Diseases

Chronic inflammatory conditions and autoimmune disorders such as systemic lupus erythematosus have long been identified as risk factors for the development of atherosclerosis. A study by Manzi et al. showed that the risk of heart attack increased 50-fold in 33 women aged 35-44 with systemic lupus erythematosus. Another example is called Sjögren's Syndrome. With this problem, the risk of cerebral artery occlusion and heart attack is twice as high.
Ankylosing Spondylitis and other spondylopathies are also associated with rapidly progressive atherosclerosis. While ankylosing spondylitis has a 2.2 increased probability of cardiovascular disease, it is stated in a study compared with other traditional risk factors that it is a stronger indicator of the need for early cardiovascular intervention.

Less Known Risk Factors in Heart Diseases

• Short Stature

Research indicates that one of the unchangeable risk factors for heart diseases is being short. According to the study published on April 8 in the New England Journal of Medicine, one of the world's leading medical journals, short people's risk of cardiovascular diseases and heart diseases is approximately 1.5 times higher than tall people. Many international studies indicate that being under 1.60 cm, regardless of gender, is a risk for cardiovascular diseases. (These data are obtained from studies conducted in developed countries of the world with a high average height.) It is stated that the results may vary depending on race and gender. A study conducted in Turkey points out that women whose height is below 160 cm are at risk for heart diseases. It is stated that larger-scale studies are needed to clarify the mentioned values.
In this problem, it is thought that the genes that are effective in determining height also play a role in controlling cholesterol levels. Although being short is among the unchangeable risk factors, it is stated that the most important point in protecting against heart diseases is to focus on factors that can be changed by not smoking, weight control and exercise, and in this way, people of short stature can reduce their personal risks.
 

• Noise Pollution

It is pointed out that long-term exposure to traffic volume noise, which increases in parallel with the ever-increasing traffic density, may increase the risk of cardiovascular diseases. Road, rail or air traffic noise has an impact on the risk of cardiovascular disease and death, with strong evidence for ischemic heart disease, heart failure and stroke. Chronic noise exposure; It can lead to physiological changes such as increased blood pressure and heart rate and the release of stress hormones such as cortisol. This condition can contribute to the development of hypertension, ischemic heart disease and other cardiovascular disorders over time. Another factor is that disrupted sleep patterns due to noise pollution pose a significant problem in terms of cardiovascular diseases. At this point, although the World Health Organization (WHO) has prepared guidelines on safe noise exposure that discuss the effects of high noise levels on the increased risk of cardiovascular disease, it is stated that these are not very effective. Considering the difficulty of changing jobs or homes to eliminate the risk, it is pointed out that it is more important to reduce the total risk by focusing on other risk factors.

• Air Pollution

Air pollution, which is known to pose a risk for many health problems, can not only aggravate existing heart diseases but also pose a risk on its own. In the measurements of people exposed to exhaust gases created by air pollution and long-term traffic, serious high blood pressure, respiratory problems and loss of vascular elasticity are detected even at that moment. These are considered factors that significantly increase the risk of heart disease. If the person has heart disease, recurrent crises occur. It is noted that this risk can be reduced by individual measures. Turning off the ignition of the vehicle in congested traffic and reducing the amount of polluted air released by using the heating and cooling of the building at an optimum level are among the precautions that can be taken individually. It is pointed out that every environmental protection measure will reduce environmental pollution. As a society, it is important to focus on exercise more, increase physical activity, park the car one stop earlier and walk, and avoid taking the car out of traffic whenever possible, both in terms of air pollution control and physical exercise.

• Long Working Hours

According to a study published in the Lancet medical journal, there is a 13 percent increase in the risk of cardiovascular disease and a 33 percent increase in the risk of stroke in those who work more than 55 hours a week, compared to those who work 35-40 hours. However, according to the latest estimates of the World Health Organization (WHO) and the International Labor Organization published in "Environment International", it is stated that long working hours caused 745 thousand deaths from stroke and ischemic heart disease in 2016. This represents an increase of 29 percent since 2000. This risk of cardiovascular diseases caused by long working hours can occur through several different mechanisms. Long working hours create work stress and pressure on the individual. Constant stress and anxiety can cause the body to release stress hormones (such as cortisol and adrenaline).
These hormones can increase blood pressure and heart rate and the risk of heart disease. Working for long hours can disrupt sleep patterns and negatively affect sleep quality. Since insufficient or poor quality sleep can increase the risk of heart diseases, a good sleep pattern is considered very important in this regard.
In addition, working long hours at a desk or in a similar position can also cause a decrease in physical activity. Low physical activity level negatively affects cardiovascular health and increases the risk of heart diseases.
Busy work schedules also bring unhealthy eating habits. Consuming fast foods, snacks or unhealthy foods that are easily accessible at work can lead to factors that increase heart diseases, such as obesity, high cholesterol and high blood pressure. It is stated that such stressful work environments can sometimes encourage smoking or excessive alcohol consumption. Precautions need to be taken to reduce the potential risks of long working hours in terms of heart diseases.

• Sleep Apnea

Sleep apnea is defined as a disorder in which breathing stops or becomes very shallow while a person sleeps. Untreated sleep apnea can increase the likelihood of high blood pressure, diabetes, and even heart attack or stroke.

• Alcohol Use

Excessive alcohol consumption can damage the heart muscle and worsen other risk factors for atherosclerosis. There is a U-shaped relationship between alcohol consumption and heart attack risk. The benefit occurs after ~28 g of alcohol (~2 Drinks or moderate consumption) in 1 day, and a high risk occurs with heavy consumption after ~108 g (~9 Drinks). This indicates that while benefits can be achieved with small purchases, the rate of harm increases as the amount increases. Within a week after alcohol consumption, the risk of heart attack is lower with moderate alcohol consumption, while the risk is greater with heavy alcohol consumption.

• Hypothyroidism

It is stated that hypothyroidism is a risk factor for atherosclerotic diseases through various mechanisms such as its negative effects on cholesterol and the increase in homocysteine, one of the parameters in the blood. It is stated that people with hypothyroidism face a 3 times higher risk of early atherosclerosis, regardless of other risk factors.