Global risk assessment in the presymptomatic patient

Cardiovascular disease is the leading cause of morbidity and mortality, bot h in the United States and worldwide. it has become widely recognized that a high percentage of cardiovascular events, including sudden cardiac death, oc-cur in previously asymptomatic individuals. Consequently, the primary p revention of cardiovascular disease, particularly coronary artery disease ( CAD), is an important objective of modem health-care policy. To identify an d target high-risk individuals for lifestyle and therapeutic interventions, aggressive screening of the healthy population at risk of developing CAD ( or other atherosclerotic disease) is necessary. Because of the complex and often synergistic relations between independent risk factors, it is also im portant that a multifactorial approach to the treatment of cardiovascular r isk factors is adopted. Although treatment guidelines and goals for certain risk factors have been published by national and international organizatio ns, recent evidence suggests that these recommendations are not always adop ted in clinical practice. Therefore, considerable potential remains for pri mary care physicians to further reduce cardiovascular morbidity and mortali ty in presymptomatic individuals. (C) 2001 by Excerpta Medica, Inc.