What risk factors cause coronary artery disease and which ones can I actually change?
Understanding the risk factors for coronary artery disease is the foundation of both preventing it in people who do not yet have it and slowing its progression in those who do. Risk factors divide into those that cannot be changed and those that can. The non-modifiable factors are age, sex (men develop coronary artery disease earlier than women on average, though women's risk rises sharply after menopause), a family history of premature coronary artery disease in a first-degree relative before the age of 55 in men or 65 in women, and prior coronary events. These factors cannot be changed, but they tell us who needs the most aggressive management of the modifiable factors. The modifiable factors are where the clinical opportunity lies. High LDL cholesterol drives the atherosclerotic process directly: LDL particles penetrate the arterial wall, oxidise, trigger inflammation, and accumulate as plaque. Reducing LDL with high-intensity statin therapy is the most evidence-supported pharmacological intervention in coronary artery disease. High blood pressure exerts continuous mechanical stress on the arterial endothelium, accelerating the sites of endothelial injury at which plaque formation begins: controlling blood pressure to below 130 by 80 mmHg significantly reduces cardiovascular risk. Type 2 diabetes accelerates atherosclerosis through multiple mechanisms and in my clinical research on patients presenting with acute coronary syndrome at Hridhay Heart Center, Gajuwaka, Visakhapatnam, I have specifically studied the relationship between HbA1c levels and coronary event outcomes: the Visakhapatnam population has a very high prevalence of type 2 diabetes, and silent coronary disease in this group is a consistent clinical challenge. Smoking is the most powerful single modifiable risk factor: its cessation produces a 50 percent reduction in recurrent coronary event risk within one year. Physical inactivity, obesity, and chronic psychological stress all contribute and all respond to lifestyle intervention. The most important clinical message is that modifiable risk factors compound each other: a patient who has elevated LDL, high blood pressure, diabetes, and smokes does not have four separate risks but a multiplicatively higher risk than any individual factor alone, and addressing all of them is what determines long-term cardiac health.
Written by Dr. K Narayana Raju, MBBS, MD, DNB Cardiology (Narayana Hrudayalaya, Bengaluru), Consultant Interventional Cardiologist, Hridhay Heart Center, Gajuwaka, Visakhapatnam 530026. Phone: +91 85999 56999.

