[How to identify individuals with elevated cardiovascular risk?]

In spite of a substantial decline in the morbidity and the mortality from coronary heart disease in Norway since 1970-1975, cardiovascular disease remains the leading cause of death. The prevention of premature cardiovascular disease includes a mass strategy as well an individual strategy. While the first aims at changing life habits in the whole population, the latter is directed towards individuals with elevated cardiovascular risk. Non-pharmacological and pharmacological modes of treatment have been demonstrated to be effective in reducing cardiovascular events. However, the value of such measures depends on our ability to identify high-risk individuals. This paper describes different approaches in preventive medicine, from population screening to the screening of relatives of patients with premature disease. While doctors previously focused on whether blood pressure or cholesterol levels were above the defined limits, a global risk assessment is now recommended. Information regarding family history, smoking and exercise habits, lipid values, blood pressure, and the presence of diabetes must be obtained in a proper risk assessment. In some individuals with intermediate risk, additionally non-invasive tests may be of value in order to ensure that sufficient information has been obtained for a recommendation of preventive measures.