Non-modifiable rask factors
Non-modifiable factors are risk factors that a patient has no control over and cannot be modified or managed. Patients should be advised that having risk factors that they cannot change makes addressing the modifiable risks even more important.
Age
Cardiovascular risk increases with increasing age, with the exception of rare inherited disorders age is the most significant risk factor for CVD.
Gender
Gender is a risk factor for cardiovascular disease with the risk being higher for men than women until the age of 75 when the risk of stroke becomes higher for women.10 In middle aged men CHD is between two and five times more common than in women, although in both sexes the risk increases significantly with age. The difference in relative risk is largest in younger patients aged between 25 and 49 years and smallest in older patients aged between 60 and 64 years. This difference in risk can be partially explained by age and gender differences in smoking, levels of total and HDL cholesterol, blood pressure, and BMI.11
Ethnicity
The risk of CVD is higher for patients of certain ethnic origins, for example, patients of South Asian origin have a risk that is approximately 1.4 times higher than European patients.10
Family history
A family history of premature cardiovascular disease, especially coronary heart disease in a parent or sibling increases the risk of the patient developing CVD by a factor of 1.3.10 Premature CHD is defined as disease occurring in men under the age of 55 and women under the age of 65.
Socio-economic factors
The risk of cardiovascular disease is strongly linked to socio-economic factors such as low income and social deprivation. The death rates from CVD have decreased in all sections of society over the past two decades but the decrease has been greater in the more affluent areas than the less affluent. Social deprivation is commonly described according to the areas ranked Townsend quintile score.
Several modifiable risk factors for CVD are linked. Social deprivation is commonly associated with poor diet, smoking and alcohol misuse with a consequent increased risk of CVD.10
Inflammatory diseases
Chronic inflammatory diseases, such as rheumatoid arthritis, are associated with an increased risk of CVD (approximately 1.4 to 1.5 fold). Whilst inflammatory disease is largely a non-modifiable risk factor patients can be advised that suppressing inflammation through the use of anti-rheumatic drugs may help to reduce the CVD risk.12
Co-morbidities
Optimal treatment and control of medical conditions such as hypertension, diabetes and chronic kidney disease that are all closely associated with an increased risk of CVD will help to minimise their impact on CVD risk.
Patients reporting sleep apnoea who are also overweight or obese should be given advice to support them to lose weight, and stop smoking if applicable. They can also be considered for treatment with a continuous positive airways device.