Coronary Artery Disease Risk Factors and Assessment

Traditional Modifiable Risk Factors

Elevated LDL cholesterol is a primary driver of atherosclerotic plaque formation, and the American Heart Association recommends management of LDL cholesterol to reduce CAD risk 1, 2
Elevated blood pressure is a robust independent predictor of future coronary events, and the American College of Cardiology recommends blood pressure management to reduce CAD risk 1
Diabetes requiring medication is classified as a high-risk enhancer for extended antithrombotic therapy decisions, and the European Society of Cardiology recommends intensive risk factor modification for diabetic patients 5
Current smoking is one of the classic risk factors with robust prognostic data, and the American Heart Association recommends smoking cessation to reduce CAD risk 1, 4

Age is the strongest independent prognostic risk factor, with risk increasing most steeply beyond 70 years, and the American College of Cardiology recommends consideration of age in CAD risk assessment 3, 4
Male sex increases likelihood of obstructive CAD compared to women with similar clinical presentations, and the European Society of Cardiology recommends consideration of sex in CAD risk assessment 3
Family history of premature CAD is associated with increased coronary artery calcium scores and 30-day cardiac event risk, and the American Heart Association recommends consideration of family history in CAD risk assessment 1, 3, 4

Chronic kidney disease with eGFR 15-59 mL/min/1.73 m² is classified as both a high-risk enhancer for extended antithrombotic therapy and a CAD risk equivalent, and the European Society of Cardiology recommends intensive risk factor modification for patients with CKD 5
Polyvascular disease is a major risk factor for poor outcomes in acute coronary syndromes, and the American College of Cardiology recommends consideration of polyvascular disease in CAD risk assessment 3, 4
Concomitant systemic inflammatory disease is classified as a high-risk enhancer for extended antithrombotic therapy, and the European Society of Cardiology recommends consideration of inflammatory disease in CAD risk assessment 5

The Framingham Risk Score or equivalent global risk instruments must be obtained for all asymptomatic adults without clinical CHD history to combine individual risk factors into a single quantitative estimate, and the American College of Cardiology recommends use of the Framingham Risk Score for CAD risk assessment 1
Patients with ≥2 major risk factors require formal 10-year CHD risk calculation to determine treatment intensity, and the American Heart Association recommends consideration of multiple risk factors in CAD risk assessment 6
The Risk Factor-weighted Clinical Likelihood model is recommended for estimating pre-test likelihood of obstructive epicardial CAD, and the European Society of Cardiology recommends use of this model for CAD risk assessment 9