Global cardiovascular risk : the role of plasma lipids.

Atherosclerosis is a multifactorial disease. This is supported by a large body of clinical and experimental data collected during the last 30 years, either in observational or in interventional clinical trials. During these years, a large number of risk factors and clinical conditions, closely related to the development of atherosclerosis, have been identified. The most relevant risk factors for cardiovascular disease are hyperlipidaemia, arterial hypertension, diabetes mellitus, cigarette smoking and family history.Cardiovascular risk factors interact with each other in a complex, and not fully elucidated fashion, contributing to the definition of a 'global cardiovascular risk profile'. Thus, the cardiovascular risk profile must be evaluated (through algorithms or risk charts) for each individual. Patients presenting with multiple cardiovascular risk factors have a higher risk of developing a major cardiovascular event, and in these patients a strict control of risk factors leads to an effective prevention of cardiovascular disease.In this latter regard, hypercholesterolemia deserves a 'dynamic' role. The most recent guidelines for the management of patients with hyperlipidaemia underscore the need for a more strict metabolic control in patients with prior cardiovascular events (secondary prevention), and also in patients with no evidence of cardiovascular disease (primary prevention), in which the concomitant presence of multiple risk factors or diabetes confers a high risk (e.g. patients with previous myocardial infarction or stroke).