Multiple Risk Factors in Cardiovascular Disease [antikvár]

PrefaceThis book includes the most significant contributions of the First International Symposium on "Multiple risk factors in cardiovascular disease", chaired by Professors A. V. Chobanian (Boston), A. M. Gotto Jr. (Houston), C. Lenfant (Bethesda), R. Paoletti and A. Zanchetti (Milan), held in Washington DC, 10-12 December 1990, which focused on the risk factors for cardiovascular disease and their interactions. The need for this symposium is based on the epidemiological evidence that individuals from industrialized countries often possess two or more risk factors which synergically increase the global risk profile. The evidence that isolated vascular risk factors are not commonly found in high risk patients but more often a combination of risk factors are detected, is highlighted. Many recent epidemiological data identifying the intrinsic and environmental factors contributing to the development of atherosclerosis are discussed. These results, in parallel to basic and clinical research, underiine how atherosclerosis is a complex and multifactorial process involving the influences of lipid deposition, blood pressure, rheologic forces, carbohydrate tolerance, and thrombogenic factors (fibrinogen and platelets). Atherosclerosis is markedly accelerated by other risk factors, more so in the presence of concomitant hypercholesterolemia, hypertension, diabetes, upper body obesity. Furthermore, the risk associated with anyone of these risk factors varies widely depending on level of the associated atherogenic risk factors.It is emphasized that, at the present time, the knowledge of the role of lipids in atherosclerosis still greatly exceeds that of any other factors involved. Thus, it is not surprising, that most data on regression of atherosclerotic lesions in humans come from studies on the efficacy of lipid lowering therapy. Hyperlipidemia is often associated to other factors which can accelerate cardiovascular disease in genetically predisposed individuals. Such factors are basically fibrinogen, hyperglycemia, low exercise, cigarette smoking. Furthermore, hypercholesterolemia and hypertriglyceridemia are more common than would be expected by chance among hypertensive patients. Hypertension also is more prevalent in those with abnormal than in those with normal lipid levels. The role of elevated blood pressure and elevated cholesterol as risk factor for coronary heart disease is repeatedly and consistently documented here. This association may be also enhanced by the contribution of upper body obesity which causes more free fatty acids to enter the liver producing effects which may elevate both liver and blood lipids. Cigarette smoking and lack of exercise can also modify their risk when associated with other risk factors.Thus, efficient assessment must quantify the joint effect of the risk factors and intervention against any risk factor is best considered in the context of the global risk profile. It is essential to consider a reduction in all risk factors involved in the development of atherosclerosis the real end point in any treatment. Special care should be used in selecting the pharmacological or non-phamiacological therapy which do not adversely affect cardiovascular profile. Hence, preventive management as well as risk estimation in individuals should be multifactorial with the goal to improve the cardiovascular risk profile, thus retarding or preventing the onset of heart or vascular disease. This is accomplished, ultimately, by causing existing lesions to regress, become stable, or progress more slowly and also by preventing the formation of new lesions.The symposium has been concluded with some strategies which should include screening on the population so as to shift the whole distribution of risk factors closer to more favorable levels; health education to enable people to take care of their health and preventive medicine for higher risk for coronary candidates. These strategies should be useful not only to specialists but to practising physicians.Professor Rodolfo PaolettiGiovanni Lorenzini Medical Foundationix