Cardiovascular disease risk factors: epidemiology and risk assessment

Current epidemiologic predictions show that the world is heading for a vascular tsunami of pandemic proportions. The number of people at high risk from cardiovascular disease is increasing; recent cohort studies suggest that only 2%-7% of the general population have no risk factors at all, and >70% of at-risk individuals have multiple risk factors. The recently published Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that telmisartan was as effective as ramipril in the prevention of a range of cardiovascular outcomes, enrolled a broad cross section of high-risk patients. This population was chosen to reflect the type of patients encountered in general practice, and because the proportion of high-risk individuals is increasing worldwide, the ONTARGET results will be relevant for most at-risk patients. Further analysis of the ONTARGET results may also aid in the development of risk estimation scores populated with real-life data and could also determine the impact of treatment on the long-term reduction of total cardiovascular burden (ie, absolute risk reduction). This may be a particularly useful exercise because current risk estimation charts have limitations in their scope, sensitivity, and the ability to reflect changes in risk.