非傳統風險因子與臨床狀況的風險評估

Nontraditional Risk Factors and Clinical Conditions for Risk Assessment of ASCVD

導致動脈硬化的風險因子可分為傳統風險因子與非傳統風險因子，傳統風險因子包括年齡、糖尿病、吸菸、高血壓、血脂異常、肥胖，這些占動脈硬化因素5成，若加上家族史，風險就更大。非傳統風險因子包括腎臟病、蛋白尿、左心室肥大、代謝症候群、慢性發炎疾病等，不少與傳統風險因子有相關性。本次將針對各位比較不熟悉的發炎／感染、性別相關因素以及代謝失調肪肝病介紹。女性動脈硬化問題，尤其在停經後風險會增加。由於雌激素可保護血管，停經後雌激素減少，使得血管更容易硬化和阻塞。懷孕期間母體心臟輸出量增加，可能使原本就有動脈硬化的女性，更容易發生主動脈剝離等嚴重併發症。不良妊娠後果（adverse pregnancy outcome，APO）是指懷孕過程發生母親或胎兒的相關併發症，近年注意到APO與母親未來發生心血管疾病有高度相關，高達10-15%女性可能發生，值得注意。另一方面，男性勃起功能障礙與心血管疾病也存在密切關聯，都與血管內皮功能障礙有關，除了年紀，跟糖尿病、吸菸、二手菸，及肥胖等有關，恰與心血管疾病危險因子相符合，因此也被認為可能是心血管疾病的早期預警信號。代謝相關脂肪肝病（metabolic dysfunction- associated fatty liver disease，MAFLD）是最常見的慢性肝病，不只會提升肝炎、肝硬化及肝癌的風險，其實和心血管疾病也有錯綜複雜的關係。MAFLD常伴隨著高血壓、糖尿病、高血脂，越來越多證據顯示會增加心血管疾病的風險。粥狀動脈硬化是從兒時開始產生，所以危險因子的監測和預防格外重要，對於這些非傳統的心血管危險因子更加了解，才能完整分析個人心血管風險，並積極預防。

Atherosclerosis can be categorized into traditional and non-traditional risk factors. Traditional risk factors include age, diabetes, smoking, hypertension, dyslipidemia, and obesity, accounting for about half of all arteriosclerosis risk factors. The risk is even greater when family history is included. Non-traditional risk factors include kidney disease, proteinuria, left ventricular hypertrophy, metabolic syndrome, and chronic inflammatory diseases, many of which are correlated with traditional risk factors. This article will focus on less familiar factors such as inflammation/infection, sex or gender-related factors, and metabolic disorders like fatty liver disease. Women face an increased risk of atherosclerosis, especially after menopause. Because estrogen protects blood vessels, the decrease in estrogen after menopause makes blood vessels more prone to hardening and blockage. Increased maternal cardiac output during pregnancy may make women with pre-existing arteriosclerosis more susceptible to serious complications such as aortic dissection. Adverse pregnancy outcomes (APO) refer to complications affecting the mother or fetus during pregnancy. Recent studies have shown a high correlation between APO and future maternal cardiovascular disease, affecting up to 10-15% of women, which warrants attention. On the other hand, erectile dysfunction in men is also closely related to cardiovascular disease, both being associated with endothelial dysfunction. Besides age, this is linked to diabetes, smoking, second-hand smoke, and obesity, which coincide with cardiovascular disease risk factors. Therefore, it is considered a potential early warning sign of cardiovascular disease. Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease. It not only increases the risk of hepatitis, cirrhosis, and liver cancer, but also has a complex relationship with cardiovascular disease. MAFLD is often accompanied by hypertension, diabetes, and hyperlipidemia, and increasing evidence shows it increases the risk of cardiovascular disease. Atherosclerosis begins in childhood, so monitoring and prevention of risk factors are particularly important. A better understanding of these non-traditional cardiovascular risk factors is crucial for a comprehensive analysis of individual cardiovascular risk and proactive prevention.