Reducing cardiovascular risk: trends in risk, risk assessment, and cholesterol management

The rate of decrease in coronary heart disease (CHD) mortality in the United States has slowed, probably in association with the aging of the population and the increasing rates of obesity, metabolic syndrome, and diabetes. Worldwide, guidelines for reducing risk of CHD and lowering lipid levels must continue to evolve to reflect disease and risk factor trends that reflect improvements in the knowledge of individual risk factors and the effects of clustered risk factors in specific patients. According to current guidelines used in the United States, Europe, and Canada for risk assessment and risk reduction, the trend is moving away from simple measurement of cholesterol and toward a more global risk assessment. An increasing number of factors are included in risk assessment, and the recommended intensity of intervention with lipid-lowering treatment continues to increase among patients considered to be at high risk.