Managing multiple cardiovascular risk factors: state of the science.

Cardiovascular risk comprises genetic, lifestyle, and metabolic factors. Risk factors frequently occur simultaneously, compounding the risk for a cardiovascular event. The most commonly occurring metabolic clustering includes elevated blood pressure, dyslipidemia (high triglyceride levels and low levels of high-density lipoprotein cholesterol), and impaired glucose tolerance or type 2 diabetes mellitus. Together with visceral obesity, this clustering of risk factors is known as the metabolic syndrome. Although the definition of the metabolic syndrome and its relevance in clinical practice are the subject of discussion, there is emerging consensus about the importance of treating all risk factors early and aggressively. Recent evidence suggests that new-onset diabetes mellitus and microalbuminuria are independent risk factors that should be considered when assessing composite cardiovascular risk. Treatment should be tailored to a patient's risk profile, with consideration of the varying effects that agents of different therapeutic classes have on cardiovascular and metabolic parameters.