Overview of atherosclerosis.

Cardiovascular disease is a serious threat to both life and health, accounting for 44% of the nation's mortality and much of its morbidity. Moreover, atherosclerotic cardiovascular disease is a growing problem because of the aging population. Coronary heart disease is the most common cause of lethal atherosclerotic disease, accounting for two thirds of all deaths resulting from heart disease and 70% of all deaths in those older than 75. A 1997 estimate put the economic cost of atherosclerotic cardiovascular disease at a staggering $259 billion. Indications are that atherosclerotic cardiovascular disease is a generalized process that involves the heart, brain, and peripheral arteries. Clinical manifestations tend to coexist, and the presence of one manifestation increases the likelihood of developing others, because major risk factors tend to affect all arterial territories. Also, clinical atherosclerosis in one area may directly predispose the patient to occurrence of atherosclerosis in another vascular territory. Therefore, measures taken to prevent one clinical manifestation of atherosclerosis should prevent the others as well. Multivariate risk profiles can identify persons at risk for atherosclerotic cardiovascular disease and target them for preventive treatment. Primary preventive measures also appear to be applicable to secondary prevention. Meta-analyses of randomized trials of the efficacy of low-dose aspirin and other antiplatelet agents in persons with overt cardiovascular disease have shown reductions of approximately 25% in the incidences of subsequent myocardial infarctions, strokes, and cardiovascular mortality. Comparison of the risk profiles for atherosclerotic cardiovascular disease indicates that correction of any particular set of risk factors or prevention of any cardiovascular disease outcome prevents other atherosclerotic disease outcomes as well. The challenge for all health care professionals is to implement comprehensive preventive measures for those at high risk for initial atherosclerotic events and even more vigorous measures for those who already have the disease.