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Managing cardiovascular risk: the need for change

Journal of Human Hypertension volume 22, pages 154–157 (2008)Cite this article

Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality worldwide, and are expected to be the leading cause of death in developing countries by 2010. The enormous impact of CVD on global health necessitates an inquiry into the existing approach to their prevention and treatment. Currently, CVD clinical guidelines focus primarily on the management of single risk factors. This approach is fundamentally flawed, since risk factors predominantly occur in clusters, meaning that the presence of a single risk factor, indeed, indicates the likelihood that others are present. Moreover, there is convincing evidence that the presence of multiple risk factors increases the severity of CVD risk, beyond that implied by simply adding the risk factors together. Thus, the comprehensive and multifactorial nature of CVD necessitates a change in CVD risk management. Cardiovascular prevention strategies are not uniform in guidelines and recommendations in different countries. In this view, managing a CVD risk continuum may represent the new treatment paradigm to be adopted in the future, with the purpose to reduce overall CVD morbidity and mortality, while redefining goals for individual risk factors based on the global risk profile. This integrated and comprehensive approach holds the best promise for improving treatment of total CVD risk, and should be implemented in healthcare policies and mostly in physicians’ practices.

During the past two decades, there has been much progress in the management of risk factors (RFs) for cardiovascular disease (CVD). However, the escalating epidemics of hypertension, diabetes and obesity, and the increasing number of people who are adopting sedentary lifestyles and unhealthy diets, threaten to stall or even reverse the favourable gains, related to better trends in individual RF management.1 Data from World Health Organization predict that patients at high cardiovascular risk will increase to 600 million in 2020 from the current 300 million.2 As treating physicians, we cannot be satisfied with the levels of CVD prevention achieved so far, and must strive to continue to address this public health epidemic and search for better ways of implementing our knowledge and clinical practice. In this perspective, accumulating evidence indicate that improving the management of CVD necessitates a significant shift in the current approach to prevention. This will require a firm move away from the current, siloed, single RF approach, that is still largely adopted by physicians, to a more comprehensive, multi-factorial approach that focuses on the total (or global) risk of the individual patient.3

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Acknowledgements

We thank Dr Giuliano Tocci, in assisting and preparing the manuscript.

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Authors and Affiliations

  1. Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant’Andrea Hospital and IRCCS Neuromed—Pozzilli, IS, Italy

    M Volpe

  2. Department of Cardiology, Lund University, Malmö University Hospital, Malmö, Sweden

    L R W Erhardt

  3. Department of Cardiovascular Sciences, University of Leicester, School of Medicine, UK

    B Williams

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  1. M Volpe
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  2. L R W Erhardt
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  3. B Williams
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Correspondence to M Volpe.

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Volpe, M., Erhardt, L. & Williams, B. Managing cardiovascular risk: the need for change. J Hum Hypertens 22, 154–157 (2008). https://doi.org/10.1038/sj.jhh.1002273

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