Research Article
Volume 7 Issue 11 - 2020
Risk Factors for Atherothrombotic Disease: A Suggested Rank Order
William E Feeman
The Bowling Green Study, United States
*Corresponding Author: William E Feeman, The Bowling Green Study, United States.
Received: August 26, 2020; Published: November 28, 2020


Risk factors for atherothrombotic disease (ATD) do not function in isolation, but rather as part of a milieu. Even so, there appears to be a rank order of importance with respect to their causality of ATD. The author presents data from the Bowling Green Study of the Primary and Secondary Prevention of Atherothrombotic Disease to show that cigarette smoking is more important than dyslipidemia, which in turn is more important than hypertension, with respect to causation of ATD. This data is taken from the ATD risk factor milieu of 870 patients who developed some form of clinical ATD during the study time frame (4 November 1974 - 1 January 2019).

The author has combined the atherogenic low-density lipoprotein (LDL) cholesterol with the anti-atherogenic high-density lipoprotein (HDL) cholesterol into a ratio termed the Cholesterol Retention Fraction (CRF, defined as [LDL-HDL]/LDL) to define dyslipidemia. This permits identification of lipid disorders across the range of lipid values seen in people who develop ATD. The author has further combined systolic blood pressure (SBP) with the CRF to create a graph that accurately characterizes-and hence predicts-the ATD population with high accuracy. This graph can be used to further characterize the ATD population with respect to average age of ATD onset, average age of multisystem ATD, and average age at death.

The prediction of the population at risk of ATD can be further characterized by dividing the graph into CRF-SBP cohorts, stratified by cigarette smoking status. When this is done it is possible to define groups of CRF-SBP cohort patient with early onset, middle-aged onset, and old-aged onset of ATD.

On the basis of these findings, it is possible to assign a rank order (in order of importance) to the various ATD risk factors. Cigarette smoking is the most important of the ATD risk factors since it causes ATD events in the youngest age groups even if the other risk factors are corrected. Similarly, dyslipidemia (as defined by the CRF) is of next importance because it is associated with earlier onset ATD than is hypertension. The author concludes that, though all ATD risk factors must be treated, treatment of a more important risk factor must not be compromised by treatment of a less important ATD risk factor.

Keywords: Atherothrombotic Disease; Framingham Heart Study (FHS); High Density Lipoprotein (HDL)


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Citation: William E Feeman. “Risk Factors for Atherothrombotic Disease: A Suggested Rank Order”. EC Cardiology 7.12 (2020): 46-60.

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