Cardiovascular and metabolic risk factors: how can we improve outcomes in the high-risk patient?

Risk assessment algorithms, such as that used in the third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program (NCEP) for treating low-density lipoprotein cholesterol, can be used to classify patients' risk for cardiovascular and metabolic problems and to determine the appropriate level of therapeutic intervention. Patients at highest risk should receive the most intensive therapy. The presence of the metabolic syndrome, a clustering of atherogenic risk factors including dyslipidemia, elevated blood pressure, elevated blood glucose, and other problems, confers additional risk for diabetes mellitus and atherosclerotic cardiovascular disease at every level of risk. Pharmacotherapy with lipid-lowering, antiplatelet, antihypertensive, or insulin-sensitizing agents to modify specific risk factors is indicated in patients at higher risk, but lifestyle change (e.g., smoking cessation, weight reduction, increased physical activity, and "heart-healthy" dietary modifications) and blood pressure control can be used across all categories of risk.