The role of multiple risk factors in cardiovascular morbidity and mortality
Ray W. Gifford, MDAddress reprint requests to R.W.G., Department of Hypertension and Nephrology, A101, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Cardiovascular disease remains the leading cause of death in the United States.OBJECTIVE
To identify important modifiable cardiovascular risk factors and appropriate interventions.DISCUSSION
The three most important modifiable risk factors are hypertension, cigarette smoking, and dyslipidemia. Systolic hypertension poses a greater risk than diastolic, but the prognostic significance of diastolic blood pressure may have been underestimated. When a smoker quits, the cardiovascular risk soon approaches that of the nonsmoker. Cardiovascular risk increases progressively with elevations of the serum total cholesterol level above 200 mg/dL. Recently identified risk factors include hyperinsulinemia and left ventricular hypertrophy.CONCLUSION
Each patient deserves an evaluation of cardiovascular risk followed by education about and therapy for those risk factors that can be changed. When more than one risk factor is present, as is often the case, the increase in risk may be synergistic rather than additive.