Psychological stress, insulin resistance, inflammation and the assessment of heart disease risk. Time for a paradigm shift?

Summary There is growing evidence that the present risk assessment protocol for coronary heart disease appears to underestimate the risk in general and the presence and progression of atherosclerosis in particular. Little or no correlation has been found between the 10-year risk based on the Framing...

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Bibliographic Details
Published in:Medical hypotheses 2008, Vol.71 (1), p.45-52
Main Author: Ware, William R
Format: Article
Language:English
Subjects:
Atherosclerosis - etiology
Atherosclerosis - physiopathology
Atherosclerosis - psychology
Depression - complications
Female
Heart Diseases - etiology
Heart Diseases - physiopathology
Heart Diseases - psychology
Humans
Inflammation - complications
Insulin Resistance - physiology
Internal Medicine
Male
Models, Cardiovascular
Primary Health Care
Risk Assessment
Risk Reduction Behavior
Stress, Psychological - complications
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Summary:Summary There is growing evidence that the present risk assessment protocol for coronary heart disease appears to underestimate the risk in general and the presence and progression of atherosclerosis in particular. Little or no correlation has been found between the 10-year risk based on the Framingham model and the extent or progression of coronary calcification. In addition, a number of studies find the protocol based on current guidelines leads to an under appreciation of the risk of symptomatic coronary heart disease or the associated fatal and non-fatal events, especially in younger asymptomatic individuals and women. Furthermore, the current guidelines give secondary importance to insulin resistance and inflammation and do not include psychosocial stress and depression, both of which are established and important risk factors for coronary heart disease. An alternative approach to risk assessment is proposed which emphasizes insulin resistance and psychological stress and depression and gives much greater recognition to inflammation as a root cause and target for intervention than is found in current guidelines. Consistent with this view, a revised assessment protocol is suggested which is still appropriate to the primary care setting and which might provide a different and perhaps more effective and relevant approach to primary prevention and risk reduction.
ISSN:0306-9877
1532-2777
DOI:10.1016/j.mehy.2008.02.008