THE CONTEXT
Cardiovascular risk is influenced by diet, obesity, alcohol use and social circumstances. Overall assessment must distinguish proportional risk increases from the actual probability of an event.
Obesity, alcohol and diet
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Obesity, particularly central or truncal obesity, is an independent risk factor and often accompanies hypertension, diabetes mellitus and physical inactivity.
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Excess alcohol consumption is associated with hypertension and cerebrovascular disease.
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Diets deficient in fresh fruit, vegetables and polyunsaturated fatty acids are associated with increased cardiovascular disease risk.
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A Mediterranean-style diet reduces cardiovascular events.
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Supplements such as vitamins C and E, beta-carotene, folate and fish oils do not reduce cardiovascular events; some have been associated with harm.
Personality and social deprivation
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Certain personality traits are associated with increased risk, but there is little evidence that stress directly causes coronary artery disease.
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Social deprivation is strongly associated with cardiovascular disease. More frequent smoking and alcohol excess may partly explain the association.
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The passage states that treatment thresholds should be lowered for patients from socially deprived areas.
Combined, relative and absolute risk
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Risk factors can act multiplicatively rather than additively. People with several risk factors are at greatest risk, so assessment should include all identifiable factors.
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Relative risk is the proportional increase in risk; absolute risk is the actual chance of an event.
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A young man with elevated cholesterol who smokes heavily can have a much higher risk of coronary death than a healthy peer while still having a small absolute chance of dying within the next decade.