Cardiovascular disease

Cardiovascular disease (CVD) includes both coronary heart disease and stroke.

Women should be assessed for risk factors for cardiovascular disease before starting HRT and given advice on optimising these where possible.

NON-MODIFIABLE RISK FACTORS:

• Age >50 years.
• Family history of CVD.
• Ethnic background. People of South Asian or sub-Saharan Africa origin have an increased risk of CVD.

MODIFIABLE RISK FACTORS:

• Smoking.
• Low blood level of high-density lipoprotein (HDL) cholesterol.
• High blood level of non-HDL cholesterol.
• Sedentary lifestyle/lack of physical activity.
• Unhealthy diet.
• Alcohol intake above recommended levels.
• Overweight and obesity.

CO-MORBIDITIES THAT INCREASE RISK:

• Hypertension.
• Diabetes mellitus (and pre/diabetes/metabolic syndrome)
• Chronic kidney disease.
• Dyslipidaemia.
• Atrial fibrillation.
• Rheumatoid arthritis, SLE and other systemic inflammatory disorders.
• Influenza.
• Serious mental health problems (schizophrenia, PTSD).
• Periodontitis.

OTHER FACTORS:

• Socioeconomic status: death from CVD is three times higher among people who live in deprived communities compared to those that live in more affluent communities.
• A lack of social support increases coronary artery disease risk.