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Rationale for multiple risk intervention: the need to move from theory to practice.

Erhardt LR - Vasc Health Risk Manag (2007)

Bottom Line: These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk.Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors.Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Medicine, Lund University, Malmö University Hospital, Malmö, Sweden. leif.erhardt@med.lu.se

ABSTRACT
Incidence of cardiovascular (CV) and metabolic disease is increasing, in parallel with associated risk factors. These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk. Evaluation of all known modifiable risk factors, to provide a detailed total CV disease (CVD) and metabolic risk-status profile is therefore necessary to ensure appropriate treatment of each factor within the context of a multifactorial, global approach to prevention of CVD and metabolic disease. Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors. Realization of the potential health and economic benefits of effective risk factor management requires improved risk factor screening, early and aggressive treatment, improved public health support (ie, education and guidelines), and appropriate therapeutic interventions based on current guidelines and accurate risk assessment. Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.

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Related in: MedlinePlus

Cumulative effects of modifiable risk factors in the INTERHEART study – risk of acute MI associated with exposure to multiple risk factors. Copyright © 2004. Reprinted with permission from Elsevier from Yusuf S, Hawken S, Ounpuu S, et al 2004. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 362:937–52.
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fig1: Cumulative effects of modifiable risk factors in the INTERHEART study – risk of acute MI associated with exposure to multiple risk factors. Copyright © 2004. Reprinted with permission from Elsevier from Yusuf S, Hawken S, Ounpuu S, et al 2004. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 362:937–52.

Mentions: The cumulative effect of modifiable risk factors was well illustrated in the INTERHEART study (Figure 1) (Yusuf et al 2004). This standardized case-controlled study of acute myocardial infarction (MI) in 52 countries enrolled 15,152 cases and 14,820 controls. The relationship of smoking, history of hypertension or diabetes, waist:hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors to MI was demonstrated. The odds ratio (OR) for the association of these risk factors to MI and their respective population attributable risk (PAR) were calculated and the nine risk factors studied were reported to collectively represent more than 90% of the risk of an initial MI. In a similar analysis conducted by Baena Diez and colleagues (2002), the association between increasing numbers of CV risk factors and the risk of suffering a major CV event was investigated in a study population of 2,248 patients. The results showed that the percentage of patients with 1, 2, 3, and 4–6 CV risk factors (from smoking, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes or obesity) was 32.8%, 17.5%, 6.9%, and 3.7%, respectively. The OR for experiencing a CV event associated to 1, 2, 3, and 4–6 CV risk factors was 1.6 (CI 95%: 0.9–2.7), 2.8 (CI 95%: 1.7–4.7), 3.6 (CI 95%: 1.9–6.5), and 5.6 (CI 95%: 2.9–10.8), respectively, again underlining the escalating risk associated with multiple risk factors.


Rationale for multiple risk intervention: the need to move from theory to practice.

Erhardt LR - Vasc Health Risk Manag (2007)

Cumulative effects of modifiable risk factors in the INTERHEART study – risk of acute MI associated with exposure to multiple risk factors. Copyright © 2004. Reprinted with permission from Elsevier from Yusuf S, Hawken S, Ounpuu S, et al 2004. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 362:937–52.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2350141&req=5

fig1: Cumulative effects of modifiable risk factors in the INTERHEART study – risk of acute MI associated with exposure to multiple risk factors. Copyright © 2004. Reprinted with permission from Elsevier from Yusuf S, Hawken S, Ounpuu S, et al 2004. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 362:937–52.
Mentions: The cumulative effect of modifiable risk factors was well illustrated in the INTERHEART study (Figure 1) (Yusuf et al 2004). This standardized case-controlled study of acute myocardial infarction (MI) in 52 countries enrolled 15,152 cases and 14,820 controls. The relationship of smoking, history of hypertension or diabetes, waist:hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors to MI was demonstrated. The odds ratio (OR) for the association of these risk factors to MI and their respective population attributable risk (PAR) were calculated and the nine risk factors studied were reported to collectively represent more than 90% of the risk of an initial MI. In a similar analysis conducted by Baena Diez and colleagues (2002), the association between increasing numbers of CV risk factors and the risk of suffering a major CV event was investigated in a study population of 2,248 patients. The results showed that the percentage of patients with 1, 2, 3, and 4–6 CV risk factors (from smoking, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes or obesity) was 32.8%, 17.5%, 6.9%, and 3.7%, respectively. The OR for experiencing a CV event associated to 1, 2, 3, and 4–6 CV risk factors was 1.6 (CI 95%: 0.9–2.7), 2.8 (CI 95%: 1.7–4.7), 3.6 (CI 95%: 1.9–6.5), and 5.6 (CI 95%: 2.9–10.8), respectively, again underlining the escalating risk associated with multiple risk factors.

Bottom Line: These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk.Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors.Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Medicine, Lund University, Malmö University Hospital, Malmö, Sweden. leif.erhardt@med.lu.se

ABSTRACT
Incidence of cardiovascular (CV) and metabolic disease is increasing, in parallel with associated risk factors. These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk. Evaluation of all known modifiable risk factors, to provide a detailed total CV disease (CVD) and metabolic risk-status profile is therefore necessary to ensure appropriate treatment of each factor within the context of a multifactorial, global approach to prevention of CVD and metabolic disease. Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors. Realization of the potential health and economic benefits of effective risk factor management requires improved risk factor screening, early and aggressive treatment, improved public health support (ie, education and guidelines), and appropriate therapeutic interventions based on current guidelines and accurate risk assessment. Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.

Show MeSH
Related in: MedlinePlus