Prevention of cardiovascular risk factors in the first place.

Cardiovascular disease (CVD) prevention can address the major risk factors-blood lipids, blood pressure, and smoking-and their determinants throughout the lifespan, with approaches varying according to age and risk. The Task Force on Research in Epidemiology and Prevention of Cardiovascular Diseases gave new impetus to the concept of early intervention: Their highest priority in CVD prevention was "to prevent the development of CVD risk in the first place." Six issues follow: (1) the relation between "primordial prevention" of CVD and "prevention of the risk factors in the first place"; (2) the place of youth in context with older and younger age groups; (3) the importance of bridging institutional gaps between youth and adulthood; (4) the need to strengthen the scientific base linking the major risk factors (e.g., blood cholesterol concentration) with their determinants; (5) the value of rate of change in risk factors with age, and not only incidence of "treatable" levels of risk factors, as an outcome in assessing interventions; and (6) the role and appropriate design strategies for both observational and intervention studies. It is time for a radical expansion of our investment in preventing the risk factors in the first place.