[Global risk and objectives in cardiovascular diseases]

The management of diseases arising from a single cause is straightforward. However, with regard to the clinical manifestations of atherosclerotic disease (coronary heart disease, stroke, peripheral vascular disease, and aneurysms) the situation is more complex, since atherosclerosis represents the product of multiple interacting risk factors. The modern approach to managing cardiovascular risks is to reduce an individual's total or global risk, rather than grading risk by individual risk factors alone. Recent guidelines stress the need for total risk estimation and recommend the use of risk charts like Framingham or SCORE before treating risk factors like dyslipidemia. One should keep in mind that treatment should be directed to those at greatest risk and management decisions based on a single risk factor may be misleading. For instance, a male smoker with a cholesterol level of 200 mg/dl and systolic blood pressure of 160 mmHg can be at four times higher risk than a female non-smoker with a cholesterol level of 300 mg/dl and systolic blood pressure of 120 mmHg, indicating a higher global risk and priority for the treatment of dyslipidemia. If risk assessment is based on the cholesterol alone, then this woman would have a higher priority than the man due to the higher cholesterol level. In this review, global risk management strategies will be discussed in detail.