Established and emerging cardiovascular risk factors

In the context of a comprehensive population strategy to reduce tobacco use, encourage healthy food choices, and increase physical activity for the whole population, the medical priority is to focus on those who have developed symptoms of coronary heart disease (CHD) or other major atherosclerotic disease, and those who are at high risk of developing such diseases in the future. To give cardiologists the best possible advice to facilitate their work in the prevention of CHD, the Joint European Societies (European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension) Task Force developed a set of recommendations on coronary disease prevention.

Published studies were reviewed, and a consensus document on risk factors and their management in cardiovascular disease prevention was developed with input from members of the Task Force representing several European and international societies devoted to the study of heart disease, family medicine and behavioral medicine.

For patients with established CHD and individuals at high multifactorial risk of developing CHD, the same lifestyle and risk factor goals have been set (blood pressure <140/90 mm Hg, total cholesterol <190 mg/dL, LDL cholesterol <115 mg/dL), and the appropriate use of prophylactic drug therapies is recommended. The role of emerging risk factors-thrombogenic factors, homocysteine, markers of inflammation, infection and genetic factors-in risk prediction and management remains to be established. The scientific evidence for established risk factors is sufficiently strong to justify preventive action at a societal and medical level.

Physicians have considerable opportunities to take preventive action, based on the present scientific evidence, to prevent CHD or other atherosclerotic diseases. However, the control of risk factors remains inadequate in many patients. Physicians are in an excellent position to motivate patients to make lifestyle changes and comply with drug therapies, to advocate better risk management in the hospital and the community, and to call for increased resources for preventive cardiology.