Abstract
Atherosclerosis is a multifactorial disease. This is supported by a large body of clinical and experimental data collected during the last 30 years, either in observational or in interventional clinical trials. During these years, a large number of risk factors and clinical conditions, closely related to the development of atherosclerosis, have been identified. The most relevant risk factors for cardiovascular disease are hyperlipidaemia, arterial hypertension, diabetes mellitus, cigarette smoking and family history.
Cardiovascular risk factors interact with each other in a complex, and not fully elucidated fashion, contributing to the definition of a ‘global cardiovascular risk profile’. Thus, the cardiovascular risk profile must be evaluated (through algorithms or risk charts) for each individual. Patients presenting with multiple cardiovascular risk factors have a higher risk of developing a major cardiovascular event, and in these patients a strict control of risk factors leads to an effective prevention of cardiovascular disease.
In this latter regard, hypercholesterolemia deserves a ‘dynamic’ role. The most recent guidelines for the management of patients with hyperlipidaemia underscore the need for a more strict metabolic control in patients with prior cardiovascular events (secondary prevention), and also in patients with no evidence of cardiovascular disease (primary prevention), in which the concomitant presence of multiple risk factors or diabetes confers a high risk (e.g. patients with previous myocardial infarction or stroke).
Similar content being viewed by others
References
Stamler J. Role of cholesterol in atherosclerosis. Acta Cardiol 1965; Suppl.11: 499+
Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979; 241: 2035–8
Dawber TR. The Framingham Study: the epidemiology of atherosclerotic disease. Cambridge (MA): 6 Harvard University Press, 1980
Russell RP, Lewis C. Results of the Multiple Risk Factor Intervention Trial (MRFIT). Md State Med J 1984; 33(1): 13–4
Aronow WS, Ahn C. Correlation of serum lipids with the presence or absence of coronary artery disease in 1,739 men and women aged >62 years. Am J Cardiol 1994; 73: 702–3
Brown G, Albers JJ, Fisher LD, et al. Regression of coronary disease as a result of intensive lipid-lowering therapy in men with high levels of apoliprotein B. N Engl J Med 1990; 323: 1289–98
Waters D, Higginson L, Gladstone P, et al. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography: the Canadian Coronary Atherosclerosis Intervention Trial. Circulation 1994; 89: 959–68
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–97
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: final report. Circulation 2002; 106: 3143–421
Wood D, De Backer G, Faergeman O, et al. Task Force Report: prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention. Atherosclerosis 1998; 140: 199–270
Panagiotakos DB, Kromhout D, Menotti A, et al. The relation between pulse pressure and cardiovascular mortality in 12,763 middle-aged men from various parts of the world: a 25-year follow-up of the seven countries study. Arch Intern Med 2005 Oct 10; 165(18): 2142–7
Castelli WP, Garrison RJ, Wilson PW, et al. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham Study. JAMA 1986; 256: 2835–8
Kannel WB, Wilson PW, Zhang TJ. The epidemiology of impaired glucose tolerance and hypertension. Am Heart J 1991; 121: 1268–73
Gordon T, Castelli WP, Hjortland MC, et al. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. Am J Med 1997; 62: 707–14
Keys A. The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol 1986; 124: 903–15
Keys A, Menotti A, Karvonen MJ, et al. Comparison of multivariate predictive power of major risk factors for coronary heart diseases in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up. J Cardiovasc Risk 1996; 3: 69–75
Russel RP, Lewis C. Results of the multiple risk factor intervention trial (MRFIT). Am Heart J 1984; 33 (1): 13-4
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9
Pyorala K, Pedersen TR, Kjekshus J, et al. Cholesterol lowering with simvastatin improves diagnosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997; 20: 614–20
West Of Scotland Coronary Prevention Study Group. Influence of pravastatin and plasma lipids on clinical events in the West Of Scotland Coronary Prevention Study (WOSCOPS). Circulation 1999; 97: 1440–5
Goldberg RB, Mellies MJ, Sacks FM, et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial. Circulation 1998; 98: 2513–9
Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol And Recurrent Events trial investigators. N Engl J Med 1996; 335: 1001–9
Prevention of cardiovascular events and death in patients with coronary heart disease and a broad range of initial cholesterol levels: the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. N Engl J Med 1998 Nov 5; 339 (19): 1349–57
Downs JR, Clearifield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998; 279: 1615–22
Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149–58
Heart Protection Study (HPS) Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 7–22
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet 2003; 361: 2005–16
Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227–39
Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364(9435): 685–96
De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur J Cardiovasc Prev Rehab 2003; 10Suppl. 1: S1–78
EUROASPIRE II Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries: principal results from EUROASPIRE II. Eur Heart J 2001; 22: 554–72
Acknowledgements
No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Catapano, A.L., Catapano, L. Global Cardiovascular Risk. High Blood Press Cardiovasc Prev 12, 125–133 (2005). https://doi.org/10.2165/00151642-200512030-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00151642-200512030-00003