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Risk factors

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Factors most strongly implicated in atherosclerosis are:

  • male sex
  • age
  • smoking - two to three fold increase in risk
  • hypertension - two to three fold increase in risk
  • diabetes - two to three fold increase in risk
  • syndrome X
  • hypercholesterolaemia:
    • there is probably no "safe" level, although 5 mmol/L is used as the cut-off
  • family history of premature coronary heart disease
    • male first degree relative's first CHD event occurred before the age of 55, or a female first degree relative's first CHD event occurred before 65

"Weaker" risk factors include:

  • use of the combined oral contraceptive pill:
    • the mini-pill does not increase the risk of heart disease
  • excessive alcohol
  • obesity
  • geographical factors:
    • low risk in Sweden and Japan
    • high risk in Scotland
  • socioeconomic class - lower social classes have a higher risk of development of heart disease in the UK
  • psychological risk factors ("stress")
    • there is strong evidence to support an association between depression, social isolation or lack of social support, and catastrophic life events and coronary heart disease (1)
  • premature menopause
  • bilateral oophorectomy - removal of both ovaries at age of 35 without subsequent HRT produces a seven fold increase in risk
  • low fibrinolytic activity - fibrinolytic activity is inversely related to smoking and obesity and positively related to exercise


  1. Bunker SJ et al. Stress and coronary heart disease: psychosocial risk factors. Med J Aust 2003;178:272-6.

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