Unusual but Real Risk Factors for Coronary Heart Disease

Unusual but Real Risk Factors for Coronary Heart Disease

Michael Garko, Ph.D.
Host of Let’s Talk Nutrition


Coronary heart disease (CHD) has been the leading cause of death in the United States since 1921 (Centers for Disease Control and Prevention, 1999). That is the bad news. The good news is that CHD is preventable. Despite that good news, it does not seem that not too many people have seized upon the principle of prevention and taken the necessary action to avert becoming a CHD statistic.

CHD constitutes more than half of all cardiovascular events in men and women less than 75 years of age. The lifetime risk of developing CHD after age 40 is 49% and 32% for men and women, respectively. Stunningly, CHD causes approximately one of every five deaths in the United States. It remains the largest foremost killer of men and women in the United States (see Lloyd-Jones, De Simone, Ferguson, et. al, 2009).

The American Heart Association (AHA) estimates that in 2009 approximately 785,000 Americans will experience a new coronary/heart attack (myocardial infarction), with approximately 470,000 having a recurrent heart attack attributable to CHD. Approximately every 34 seconds an American will experience a coronary attack and approximately 37% of those who have a heart attack in a given year will die from it (see Lloyd-Jones, De Simone, Ferguson, et. al, 2009). .

Becoming aware of various risks factors is a key strategy in helping you to prevent CHD. In this June, 2009, issue of Healthful Hints, some unusual or otherwise out of the ordinary but real risk factors for CHD are discussed. This month’s issue is intended to augment the August, September and October, 2006, issues of Healthful Hints in which basic concepts, issues and types of risk factors associated with CHD were discussed (see Garko, 2006a, 2006b & 2006c).

Why You Need To Know the Risk Factors for CHD

What makes CHD so insidious is that it develops silently in a stealth-like fashion over the lifetime of a person without any symptoms. Then suddenly it rears its ugly head. Fifty percent of men and 64% of women who die suddenly of CHD exhibit no prior symptoms (see Lloyd-Jones, De Simone, Ferguson, et. al, 2009). Thus, given its stealth-like pathological development, it would be prudent to learn about the risk factors for CHD.

Having a basic understanding of the risk factors for CHD can help (1) determine if you may be at risk, (2) assess your level of risk, (3) teach you about the early warning signs for CHD and (4) make you more vigilant and health conscious, all of which reduces the danger of suffering or dying from CHD.

Classification of Risk Factors

Classifying risk factors for CHD as modifiable and non-modifiable is a frequently used approach to sort out its pathological pathways. Non-modifiable risk factors involve genetically determined traits (e.g., age, gender & race-ethnicity), while modifiable risk factors involve lifestyle variables (e.g., excessive alcohol & tobacco use, high stress levels, lack of exercise & physical activity, poor nutrition, etc.) and acquired conditions (e.g., elevated blood pressure, overweight-obesity, insulin resistance, etc.). Lifestyle and acquired conditions are assumed to be changeable, improvable, and preventable, while heredity based factors are viewed as unchangeable.

Multi-Factorial Disease

It is important to remember that similar to other degenerative diseases, CHD is not caused by a single variable. Although some risk factors are considered independent (e.g., smoking) because they can single-handedly cause it, CHD is a multi-factorial disease. The research on CHD provides convincing evidence that it stems from a complex of interacting traits, acquired conditions and lifestyle variables that implicate various environmental, behavioral, psychological, physiological, social and genetic factors. As it turns out, risk factors most often interact and work together with one another to create a greater likelihood of developing CHD and produce a greater deleterious impact on a person’s cardiovascular health.

Out of the Ordinary Risk Factors

As medical science has continued to makes advances in determining the pathological processes of CHD, it has identified some out of the ordinary but nonetheless important risk factors for CHD, including panic disorder and depression, periodontal disease, workplace justice and quality of neighborhood.

These risk factors are out of the ordinary in that the average person might not think of them as linked to CHD and because they are uniquely different from the constellation of traditionally recognized risk factors for CHD (e.g., high blood pressure, high blood cholesterol, diabetes, obesity, physical inactivity & smoking).

Panic Disorder and Depression

Gomez-Caminero et al. (2005) conducted a cohort study involving a total of 39,920 patients suffering from panic disorder (PD) and an equal number of patients without PD. After controlling for age at entry into the cohort, tobacco use, obesity, depression, and use of medications such angiotensin converting enzyme inhibitors, beta blockers and statins, they found an association between PD and CHD and association between PD and depression. Those patients with PD had nearly double the risk of CHD, while patients diagnosed with depression were at almost three times the risk of suffering from CHD.

Periodontal Disease

Geismar et. al (2006) found a positive correlation between periodontal disease and CHD. This finding was in agreement with a number of previous epidemiological studies showing a correlation between periodontal disease and CHD.

Compared to study participants who did not suffer from CHD, those who were diagnosed with CHD had an increase in signs and symptoms of periodontal disease, especially alveolar bone loss, clinical attachment loss and bleeding gums. In fact, those participants below the age of 60 who exhibited more than four millimeters of alveolar bone loss were found to be at an increased risk for CHD.

Researchers are uncertain about whether there is a causal relationship between periodontal disease and CHD. It is hypothesized in the literature that the chronic infections and inflammation stemming from periodontal disease may be implicated in the initiation of and development of atherosclerosis, the underlying disease process for CHD. Specifically, it is speculated that periodontal bacterial may infect the walls of the coronary arteries or bacterial products located in the periodontal pockets of the gums may trigger the initiation and progression of atherosclerosis.

Workplace Justice

Kivimaki et. al (2005) investigated whether workplace justice was a predictor of CHD among 6,442 men working in office staff positions in 20 civil service departments located in London, England. After adjusting for cholesterol concentration, hypertension, body mass index, smoking, alcohol consumption, physical inactivity and other psychosocial work-related characteristics, Kivimaki and her co-researchers found that employees who experienced a high level of workplace justice experienced a lower risk of CHD compared to employees who experienced a low or an intermediate level of justice at work. Specifically, men who perceived a high level justice in their workplace had a 30% lower risk of CHD than men perceived a low or an intermediate level of justice in their workplace.

In background information contained in their study, the authors reported that employees tend to feel a sense of workplace justice when their supervisors take their viewpoints into account, shares information related to decision-making and treats people in a fair and truthful manner. They suggest that perceived high levels of workplace justice may play a role in reducing chronic stress and its impact on and association with CHD.

Quality of Neighborhood

Roux et. al (2001) set out to learn whether the quality of neighborhood of residence was risk factor for CHD. The authors contended that where people live is not typically considered to be a predictor of their health. Rather, according to them, a person’s lifestyle and genetics tend to occupy researchers’ explanations for the causes of disease. Yet, they pointed to studies showing that the socioeconomic environment of where a person lives (i.e., neighborhood of residence) has an impact on health status, mortality and health-related behaviors (e.g., smoking, dietary habits & physical activity).

The authors hypothesized that the characteristics of a neighborhood or otherwise its own socioeconomic status was independent of a person’s socioeconomic position in terms of health outcomes, all of which suggests that the attributes of neighborhoods themselves could have an important impact on health (see Roux et. al, 2001).

At the end of the research day, Roux et. al (2001) found that CHD was more likely to develop in those individuals living in the most disadvantaged neighborhoods compared to persons living in the most advantaged neighborhoods. This finding sustained even after for controlling for personal socioeconomic characteristics (see Roux et. al, 2001).


If CHD is to be prevented, then health consumers need to take personal responsibility in maintaining their cardiovascular health. A first step in that direction is for them to learn about risk factor basics for CHD. Having this kind of knowledge can assist in (1) assessing (with the help of a healthcare professional) the likelihood of developing CHD and (2) eliminating or at least reducing the impact of specific risk factors such as high blood pressure, high blood cholesterol, diabetes, obesity, physical inactivity and smoking.

However, preventing CHD begins with taking the personal responsibility to learn about not only those factors that create the risk of developing CHD but also those factors (e.g., panic disorder and depression, periodontal disease, workplace justice & quality of neighborhood) which tend to fall outside of the mainstream of well-established risk factors.


Garko, M. (2006a). Cardiovascular health – Part IV: Risk factor basics to understand coronary heart disease. Healthful Hints, August issue. Retrieved May 15, 2009 http://www.letstalknutrition.com.

Garko, M. (2006b). Cardiovascular health – Part V: Non-modifiable risk factors for coronary heart disease. Healthful Hints, September issue. Retrieved May 15, 2009 http://www.letstalknutrition.com.

Garko, M. (2006c). Cardiovascular health – Part VI: Modifiable risk factors for coronary heart disease. Healthful Hints, October issue. Retrieved May 15, 2009 from http://www.letstalknutrition.com.

Geismar K., et. al (2006). Periodontal disease and coronary heart disease. Journal of Peridontal 77 (9), 1547-1554.

Gomez-Caminero A., et. al (2005). Does panic disorder increase the risk of coronary heart disease? A cohort study of a national managed care database. Psychosomatic Medicine 67(5), 688-691.

Kivimäki M., et. al (2005). Justice at work and reduced risk of coronary heart disease among employees: the Whitehall II Study. Archives of Internal Medicine. 165 (19), 2245-2251.

Roux, A., et. al (2001). Neighborhood of residence and incidence of coronary heart disease. New England Journal of Medicine 345 (2), 99-106.