Coronary Heart Disease Risk Factors - Part II
Emerging Risk Factors

Presumably, you are reading this series after reading Part I - there, we have presented the conventional risk factors that identify people at high risk. If you are not familiar with that information, please Click Here to start there.

The topics being discussed in this section are still being debated. The information we are presenting is up-to-date as of the last modification date at the bottom of the page. We will attempt to update it as new information becomes available.

The issue we are trying to resolve is how we can improve the risk assessment for CHD. If we consider a male person, total cholesterol =240, HDL of 30, smoker, systolic blood pressure of 170 on medication for hypertension, the Framingham calculator provides a greater than 30% risk for CHD. This number implies that around 6 out of 10 people in this category will not contract CHD in this period. Never the less, we would treat all 10 people in this group, because of their high risk, and because we don't know apriori who among them will actually get CHD. Ideally, we wish there would be a better way to differentiate between those who will get CHD, and those who won't.

In contrast, the lowest risk 65 year old male (total cholesterol of 180, HDL of 65, non-smoker, blood pressure of 115 without medication) has a 10 year risk of 7%. We would like to defer treatment for the low-risk people, not wishing to treat 93 out of 100 people who will not get sick. We would also like to be able to determine at the start who the 7 people who would get ill are, and treat them appropriately.

The risk ratio between the highest ( greater than 30%) and the lowest (7%) is less than a factor of 5. We would like to achieve a much higher relative risk ratio - this is equivalent to knowing in advance who will get sick and who will not.

In the following, we will present other risk factors that might have the ability to accomplish this type of differentiation. We again note that their efficacy is still being debated by the medical community.

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