The treatment of coronary heart disease: an update. Part 1: An overview of the risk factors for cardiovascular disease.

Cardiovascular disease (CVD) is the main cause of death. Atherosclerosis of coronary arteries is responsible for almost all cases of CVD. The term 'risk factor' describes all those characteristics found in healthy individuals that are independently related to subsequent development of CVD. It includes modifiable biochemical and physiological characteristics, such as hypercholesterolaemia, hypertension, cigarette smoking, diabetes mellitus, obesity and low HDL cholesterol levels, as well as non-modifiable personal characteristics, such as age, gender and family or personal history of early onset CVD. In addition to the 'classic' risk factors mentioned above, several other variables have been implicated as predictors of CVD: left ventricular hypertrophy; infectious agents; markers of inflammation; oxidative stress; and increased levels of fibrinogen, triglycerides, homocysteine and Lp(a)]. However, controversy exists regarding the exact role of these variables in the pathogenesis of atherosclerosis. Furthermore, there are no conclusive data showing that the modification of these variables is associated with a decrease in the incidence of cardiovascular events. Nevertheless, these 'new' risk factors should be taken into account in patients with CVD without established risk factors.