Risk Factors for Atherosclerosis

Risk Factors for Atherosclerosis
Status	Risk Factor
Nonmodifiable	Age Family history of premature atherosclerotic cardiovascular disease and genetic predisposition* Male sex† Ethnicity (eg,South Asian ancestry)
Modifiable	Dyslipidemia (lipid abnormalities): High non-HDL and high LDL level, especially small, dense LDL High apolipoprotein B (ApoB) level High lipoprotein (a) level Hypertriglyceridemia Cardiovascular-kidney-metabolic factors: Diabetes mellitus and insulin resistance Hypertension Obesity, especially central obesity Chronic kidney disease Inflammation: High C-reactive protein (CRP) level Systemic inflammatory diseases (eg, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, vasculitides) Clonal hematopoiesis of indeterminate potential (CHIP) Infection: HIV Chlamydia pneumoniae Cytomegalovirus Helicobacter pylori Periodontal disease Severe acute respiratory syndrome coronavirus-2 (COVID-19) Influenza Respiratory syncytial virus (RSV) Lifestyle: Tobacco smoking Sedentary lifestyle Dietary factors such as low intake of fruits and vegetables Psychosocial factors (eg, chronic stressors, anger and hostility, depression, anxiety, socioeconomic status) Alcohol intake (other than moderate) Other: Prothrombotic states (eg, hyperfibrinogenemia, high plasminogen activator inhibitor level) Radiation therapy to thorax Treatment with chemotherapy agents (eg, anthracyclines, taxanes, tyrosine kinase inhibitors, immune checkpoint inhibitors) Conditions specific to women (eg, adverse pregnancy outcomes such as. preeclampsia, premature menopause)
* Atherosclerotic cardiovascular disease is considered premature when it occurs in a male first-degree relative before age 55 years and in a female first-degree relative before age 65 years. Atherosclerotic cardiovascular disease includes coronary artery disease (myocardial infarction, angina or coronary artery stenosis), cerebrovascular disease (transient ischemic attack, ischemic stroke, carotid stenosis), peripheral artery disease, and aortic atherosclerotic disease.
† Atherosclerosis is increasingly prevalent in young women and women members of minority groups and populations in developing countries.
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):e177-e232. doi:10.1016/j.jacc.2019.03.010; Hamad R, Penko J, Kazi DS, et al. Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults. JAMA Cardiol. 2020;5(8):899-908. doi:10.1001/jamacardio.2020.1458; Izquierdo-Condoy JS, Arias-Intriago M, Becerra Cardona DA, García-Cañarte S, Vinueza-Moreano P. Anticancer Chemotherapy-Induced Atherosclerotic Cardiovascular Disease: A Comprehensive Review. Life (Basel). 2025;15(2):245. doi:10.3390/life15020245; Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947; Libby P, Buring JE, Badimon L, et al. Atherosclerosis. Nat Rev Dis Primers. 2019;5(1):56. doi:10.1038/s41572-019-0106-zPandey AK, Blaha MJ, Sharma K, et al. Family history of coronary heart disease and the incidence and progression of coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2014;232(2):369-376. doi:10.1016/j.atherosclerosis.2013.11.042; Szwed P, Gąsecka A, Zawadka M, et al. Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications. J Clin Med. 2021;10(12):2539. doi:10.3390/jcm10122539.
CRP = C-reactive protein, HDL = high-density lipoprotein cholesterol, LDL = low-density lipoprotein cholesterol.

* Atherosclerotic cardiovascular disease is considered premature when it occurs in a male first-degree relative before age 55 years and in a female first-degree relative before age 65 years. Atherosclerotic cardiovascular disease includes coronary artery disease (myocardial infarction, angina or coronary artery stenosis), cerebrovascular disease (transient ischemic attack, ischemic stroke, carotid stenosis), peripheral artery disease, and aortic atherosclerotic disease.

† Atherosclerosis is increasingly prevalent in young women and women members of minority groups and populations in developing countries.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):e177-e232. doi:10.1016/j.jacc.2019.03.010; Hamad R, Penko J, Kazi DS, et al. Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults. JAMA Cardiol. 2020;5(8):899-908. doi:10.1001/jamacardio.2020.1458; Izquierdo-Condoy JS, Arias-Intriago M, Becerra Cardona DA, García-Cañarte S, Vinueza-Moreano P. Anticancer Chemotherapy-Induced Atherosclerotic Cardiovascular Disease: A Comprehensive Review. Life (Basel). 2025;15(2):245. doi:10.3390/life15020245; Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947; Libby P, Buring JE, Badimon L, et al. Atherosclerosis. Nat Rev Dis Primers. 2019;5(1):56. doi:10.1038/s41572-019-0106-zPandey AK, Blaha MJ, Sharma K, et al. Family history of coronary heart disease and the incidence and progression of coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2014;232(2):369-376. doi:10.1016/j.atherosclerosis.2013.11.042; Szwed P, Gąsecka A, Zawadka M, et al. Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications. J Clin Med. 2021;10(12):2539. doi:10.3390/jcm10122539.

CRP = C-reactive protein, HDL = high-density lipoprotein cholesterol, LDL = low-density lipoprotein cholesterol.

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Atherosclerosis