(Circulation. 1999;100:1930-1938.)
© 1999 American Heart Association, Inc.
Current Perspectives |
Coronary Heart Disease: Reducing The Risk
A Worldwide View
From the Institute of Arteriosclerosis Research and Institute of Clinical Chemistry and Laboratory Medicine, University of Münster, Germany (G.A., P.C); Faculty of Medicine, University of Valencia, Spain (R.C.); Department for the Study of Lipids and Lipoproteins, Institut Pasteur de Lille, France (J.-C.P.); Department of Clinical and Experimental Medicine, University of Naples, Italy (F.J., M.M.); University of London, UK (B.L.); Faculty of Pharmacy, University of Milan, Italy (R.P.)
Correspondence to Gerd Assman, FRCP, Institut fuer Arterioskleroseforschung, Universitaet Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
Key Words: cardiovascular diseases • risk factors • hyperlipidemia
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Introduction |
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Worldwide, cardiovascular diseases are now the most common cause of death and a substantial source of chronic disability and health costs. In the light of new data from clinical trials and a fuller understanding of risk factors, the International Task Force for the Prevention of Coronary Heart Disease, in cooperation with the International Atherosclerosis Society, prepared a revised and comprehensive statement regarding the scientific basis of the primary and secondary prevention of cardiovascular disease. The following is a short account of the clinical implications of this statement. It is best read in conjunction with the full document, which can be found at http://www.chd-taskforce.com
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Assessing the Global Risk of Cardiovascular Disease |
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Assessing a patient's overall or global risk of cardiovascular disease is the first step in preventive care, for it enables the physician to identify and provide the appropriate level of treatment for risk factors. Much can be learned from measuring even a few risk factors. The fuller the knowledge of the patient's risk status, the sounder the treatment decisions. Initial costs may be offset by long-term rational treatment. The goals of treatment and, hence, the extent of dietary change and the need for (and choice and dosage of) drug treatment all depend on global risk assessment. Two methods for determining global risk follow.
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Method I |
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Note and tabulate the following risk factors, including those laboratory investigations that are available.
Age, Sex, and Menopausal Status
Risk increases progressively with adult age, and coronary
heart disease (CHD) is most common after the age of 60 years. In
premenopausal women, CHD is rare (except in those who
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