From individual risk factors to global cardiovascular risk

Individual risk factors and CHD prevention in the past

In the 1960s and 70s, the Seven Countries Study and many other studies identified serum cholesterol, systolic blood pressure and smoking as major risk factors of CHD. Since then, smoking cessation and dietary interventions were promoted for primary prevention with drug treatment recommended for strongly elevated serum cholesterol and/or blood pressure levels.

Risk of major CHD events in 3 hypothetical subjects: Mr A, B, or C
Identification of high-risk individuals and treatment of global CVD risk

The accuracy of CHD risk evaluation improved when the risk factors were considered simultaneously. The table shows that three individuals with different combinations of risk factors have the same overall risk. Formerly, most clinicians treated only individuals with very high serum cholesterol and/or blood pressure levels but not those with slightly elevated levels of all three risk factors, who, in fact, had the same risk. Because the major risk factors predict not only CHD but also overall CVD risk, treatment of high-risk individuals is nowadays based on “global” CVD risk. The treatment adage has become: “the lower the risk factor levels, the better”.