Task force 3. Spectrum of risk factors for coronary heart disease

Abstract

In matching management intensity with cardiovascular risk, we proposed a scheme of categories of descending levels of evidence to support the benefit of direct management. That is, we began with those risk factors for which the most conclusive evidence exists and whose management favorably affects outcomes, and we ended with those factors for which management opportunities are minimal or absent or for which modification would not or could not alter the course of the disease. The proposed risk factor categories are as follows: I. Risk factors for which interventions have proved to reduce the incidence of coronary artery disease events (cigarette smoking, LDL cholesterol, hypertension, thrombogenic factors). II. Risk factors for which interventions are likely, based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of coronary artery disease events (diabetes, physical inactivity, HDL cholesterol, obesity, postmenopausal status). III. Risk factors clearly associated with an increase in coronary artery disease risk and which, if modified, mightlower the incidence of coronary artery disease events (psychosocial factors, triglycerides, Lp(a), homocysteine, oxidative stress, alcohol consumption). IV. Risk factors associated with increased risk but which cannot be modified or whose modification would be unlikely to change the incidence of coronary disease events (age, gender, family history and many others). Dietary modification is important throughout the course of evaluation and management of many of the major risk factors. Therefore, “diet” has not been included in the list of risk factors as categorized in this task force. Rather, we recognize that diet interacts with different risk factors at many different levels. If diet were to be included, it would qualify for category I status.