Coronary risk factors: new perspectives

The predisposing and precipitating causes of acute myocardial infarction Ml ) are multiple; furthermore, different individuals may have different susce ptibility, to a large extent genetically determined, to each of them. in sp ite of the complex aetiology of Mi and of our limited knowledge of the caus es responsible for the formation of persistent occlusive thrombosis in epic ardial coronary arteries, the achievements obtained by controlling traditio nal risk factors are remarkable. Traditional risk factors, however, have a limited sensitivity among subjects with low/moderate levels of risk. Furthe rmore, in particular among subjects at medium risk, current preventive stra tegies are limited by the low incidence of preventable events which makes i t necessary to also treat the vast majority of subjects who would not devel op cardiac events even without any treatment. An improvement in preventive strategies for HID can be achieved with the identification of: (1) new risk factors; (2) genotypes enhancing the susceptibility to specific risk facto rs; (3) phenotypes and genotypes making patients susceptible to specific pr eventive strategies; (4) genotypes protecting from risk factors. Although a word of caution is necessary as a number of recent studies on genetic mark ers, on new risk factors and on the interaction between genetic markers and environment have failed to withstand the rigour of population-based studie s, the early findings available to date suggest that cost-effective prevent ive strategies based on individual susceptibility to specific predisposing and precipitating causes of MI may become a reality in the foreseeable futu re.