Risk factors for cardiovascular disease and death: a clinical perspective.

Coronary artery disease has been demonstrated to conform to the principles of an epidemic disease. Therefore, the incidence of the occurrence of the disease is dependent in large part on "disturbances of human culture." These primarily include a cholesterol-rich diet, obesity, cigarette smoking, elevated blood pressure and sedentary life-style. It is gratifying that during the last quarter of a century, large segments of society in the United States have modified many of their adverse patterns of living. As a result, there has been a striking decline in both the incidence of the diagnosis of coronary artery disease and the frequency of premature death due to the disease process. Sudden cardiac death is frequently an unexpected first clinical manifestation of coronary artery disease and, despite heroic efforts, treatment of sudden death victims is frequently unsuccessful. Furthermore, progression of coronary artery disease, even in patients who present with angina pectoris or acute myocardial infarction, is unpredictable. Coronary arteriography, the "gold standard" used for evaluation, gives insight primarily into anatomy and ventricular function (under experimental conditions) existing at a given instant in time. Which lesions are serious and likely to progress are usually unknown, even to the most experienced angiographer. Therefore, surgical and catheter-directed therapeutic approaches are at best only "shotgun" or partial techniques. For these reasons, the principal and continuing therapeutic efforts to reduce the occurrence and control the ravages of coronary artery disease should be directed toward prevention. Such efforts should begin in early childhood and become a lifelong practice, one that all physicians, including the most procedure-dominated specialists, should personally adopt and teach.(ABSTRACT TRUNCATED AT 250 WORDS)