Global risk assessment in the presymptomatic patient.

Cardiovascular disease is the leading cause of morbidity and mortality, both in the United States and worldwide. It has become widely recognized that a high percentage of cardiovascular events, including sudden cardiac death, occur in previously asymptomatic individuals. Consequently, the primary prevention of cardiovascular disease, particularly coronary artery disease (CAD), is an important objective of modern health-care policy. To identify and target high-risk individuals for lifestyle and therapeutic interventions, aggressive screening of the healthy population at risk of developing CAD (or other atherosclerotic disease) is necessary. Because of the complex and often synergistic relations between independent risk factors, it is also important that a multifactorial approach to the treatment of cardiovascular risk factors is adopted. Although treatment guidelines and goals for certain risk factors have been published by national and international organizations, recent evidence suggests that these recommendations are not always adopted in clinical practice. Therefore, considerable potential remains for primary care physicians to further reduce cardiovascular morbidity and mortality in presymptomatic individuals.