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Cardiovascular disease is the leading cause of death
and disability worldwide. Although our understanding
of this disease has progressed enormously, we have
much to improve in identification of the disease and
applying optimal treatments to prevent progression of
disease and its consequences.
Beginning nearly 50 years ago, the Framingham
Heart Study forever changed our approach to coronary
artery disease by identifying major risk factors for
myocardial infarction (MI) – namely hypertension,
smoking, hypercholesterolemia, diabetes and a family
history of MI. Since then, countless other risk factors
and markers of disease have been identified. Our current
approach to prevention (either primary prevention
of a first event, or secondary prevention of
recurrent events) is largely focused on controlling
these individual risk factors. This single risk factor
approach has led to multiple classes of drugs to treat
each condition, and guidelines are developed centered
on improvements of each one (e.g., hypertension –
JNC VII, or the ADA) In addition, decades ago, the
United States government established national programs,
such as the National Cholesterol Education
Program (NCEP) that develops guidelines for management
of cholesterol. |
