Risk Factors

Risk factors are elements describing the patient tendency to develop a cardiac disease. Physician can tell if the patient is affected or not by a given risk factor using a radio button structure with double choice, Yes or No, except for Allergies, to which a free text field is given.

Smoking

Smoking greatly increases risk of having heart attack. It reduces the ability of blood in carrying oxygen. If there is less oxygen in blood, the heart has to work harder to pump blood to deliver the correct amount of oxygen to all body.

Tobacco products also make blood clots more likely to form, and increase the amount of plaque build-up in arteries. These two conditions increase the probability of a heart attack.

Smoking also increases the stiffness of blood vessels making harder for them to expand and contract as needed, and more likely to split.

These changes to the arteries can cause not only a heart attack, but also stroke or angina [12].

Hypertension

The excess strain and resulting damage from high blood pressure (hypertension) causes the coronary arteries serving the heart to slowly become narrowed from a build-up of fat, cholesterol and other substances that together are called plaque.

This slow process is known as atherosclerosis.

When a coronary artery becomes blocked by those substances, the flow of blood through the vessel is interrupted starving the heart of oxygen and nutrients, causing heart attack [13].

Dyslipidaemia

Lipid abnormalities, including high levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein choles-terol (HDL-C), are associated with an increased risk of Cardio Vascular diseases [14].

Diabetes

People with diabetes are more likely to develop heart diseases and have a greater chance of a heart attack. They are also more likely to have other risk factors, as high blood pressure and high cholesterol. Moreover, high blood glucose from diabetes can damage blood vessels and nerves controlling them and the heart.

People with diabetes tend to develop heart diseases at a younger age than people without diabetes [15].

Family history of Coronary Artery Disease

Having Family History of Coronary Artery Disease means to have first degree rel-atives who had a cardiovascular event in young age (less than 55 years in men and less than 65 in women) [16].

Even if the environment and the life style are key elements in causing them, it is proved that cardiovascular diseases are influenced by genetics [17].

Previous Chemotherapy

Chemotherapy side effects may increase the risk of heart disease, including weaken-ing of the heart muscle and rhythm disturbances. Certain types of chemotherapy also may increase the risk of heart attack.

Anthracycline drugs are most commonly linked to changes of the heart muscle but fortunately, heart disease associated with chemotherapy is rare and not all chemotherapy drugs carry the potential side effect of heart damage [18] [19].

Previous Radiotherapy

Radiation therapy to the chest area often is part of the treatment for Hodgkin lymphoma and cancers of the lung, esophagus, or breast. Cardiotoxicity is a risk when a large volume of heart muscle is exposed to a high dose of radiation [20].

Although more modern treatment often involves lower cardiac doses and can therefore result in lower risk, there is evidence that an increased risk in develop-ing cardiovascular disease remains for patients treated for Hodgkin lymphoma and others cancers [21].

HIV in treatment

HIV has been found to directly affect vascular biology resulting in an increased risk of cardiovascular disease compared to uninfected persons. Moreover, some cardiovascular medications can interact with HIV drugs and should not be used together.

HIV caused chronic inflammation, hypercoagulability and platelet activation all contribute to endothelial dysfunction, leading to higher risk for cardiovascular events [22].

Kidney Failure

Heart disease is the most common cause of death among people who have kidney disease. Moreover, they share two of the same main causes: diabetes and high blood pressure.

High blood pressure is not only a cause of kidney disease; kidney disease is also a cause of high blood pressure. When you have damaged kidneys, they may be unable to filter extra water and salt from your body. The high blood pressure that results can then make kidney disease worse. Worsening kidney disease can raise blood pressure again. A dangerous cycle results as each disease makes the other worse [23].

Allergies

Allergies may have an impact on heart and cardiovascular system. They can trig-ger a chronic train reaction. Allergies are a well-known cause for asthma. When the mucous membranes are inflamed over a longer period of time, an allergy can also predispose to bronchitis. Chronic lung disease may lead to right ventricular enlargement and failure.

Moreover, the combination of physical stress and a weakened immune system caused by allergies can lead to a weakening of the heart muscle and can give rise to heart muscle inflammation [24].

Figure 3.4: Risk Factors Form

Figure 3.4 shows the form for inserting Risk Factors. As explained at the begin-ning of this section (3.5.1) all choices are of boolean type, except for Allergies. In this field, the physician can write free text to better describe the patient’s situation, and all will be saved into the Firebase Database.

The information stored during an examination can be modified and updated in following ones.

In the form, "Fumatore" stands for Smoker, "Iperteso" stands for Hypertensive,

"Dislipidemico" stands for Dyslipidemic, "Diabetico" stands for Diabetic. "Familiar-ità per malattia coronarica" means the patient has a Family History of Coronary Artery Diseases, "Pregressa chemioterapia" and "Pregressa radioterapia" mean the patient has been respectively subjected to Chemotherapy or Radiotherapy. "HIV in terapia" means the patient is actually receiving a treatment for HIV virus. "Insuffi-cienza renale severa" stands for Kidney Failure, while "Allergie" stands for Allergies.