Cardiovascular disease: risk factors, secular trends, and therapeutic guidelines.

A brief review of cardiovascular disease incidence and risk factors for coronary heart disease and cardiac failure is presented. Secular trends in cardiovascular disease risk factors, morbidity, and mortality are a major focus. Declines in cardiovascular disease mortality over the past 30 yr, a more modest decline in coronary heart disease, and an increase in cardiac failure are demonstrated. Emphasis is placed on evidence from large-scale, prospective, observational and interventional studies, and the pertinent U.S. guidelines and recommendations for care are provided. Consideration is given to the major risk factors, including lipids, blood pressure, smoking, and diabetes mellitus. Additional information is also given concerning the role of vitamins, homocysteine metabolism, and left ventricular hypertrophy. Although this review focuses on commonly accepted risk factors in the general population, where appropriate, specific information that is relevant to patients with chronic renal disease is provided.