Cardiovascular disease and multifactorial risk: challenge of the 1980s.

The natural history of the atherosclerotic cardiovascular diseases is reviewed in terms of the risk factor parameters in the Framingham Heart Study population over a period of 18 years. The author stresses the importance of multifactorial approach to risk factor management. Two practical tools are offered for physician use. One is a precise number evaluation system that calculates risk by means of five parameters (total cholesterol, systolic blood pressure, absence or presence of diabetes mellitus, ECG evidence of left ventricular hypertrophy, and cigarette smoking) and a multiplier for high-density lipoprotein cholesterol. The other, a more general tool, is easily memorized and does not require attention to a set of tables, as does the number evaluation system. It is a categorical checklist that provides cutoff values for all risk factors as an aid in identifying those patients whose overall middle-value profile places them at high risk.