Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular Risk Management in Clinical Practice

Time to Change

  • Review Article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Cardiovascular disease (CVD) still represents the leading cause of morbidity and mortality in Western countries and is expected to rise further, worldwide, in the future. The enormous impact of CVD on global health necessitates an inquiry into improvement of the existing approach to treatment. The common observation that CVD risk factors often occur in clusters may indeed represent a clinical opportunity because of the fact that the presence of a single risk factor indicates the likelihood that others are present. Clustering of multiple risk factors increases the severity of CVD risk, beyond that implied by simply adding the risk factors together. Physicians understand the multifactorial nature of CVD; in practice, they tend to treat risk factors in isolation, rather than addressing the global CVD risk continuum. A more comprehensive and effective approach to the multifactorial nature of CVD is needed. Managing the CVD risk continuum is a new treatment paradigm that can be moved forward. Tools are available to support this new model. Implementing this paradigm will help to target overall CVD risk while maintaining specific therapeutic goals for individual risk factors. This synergistic approach holds the best promise for treating total CVD risk, and reducing the mounting burden of CVD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organization. Program and projections of the world health organization on cardiovascular diseases [online]. Available from URL: http://www.who.int/cardiovascular_diseases/en/ [Accessed 2008 Jan 31]

  2. Schober SE, Mirel LB, Graubard BI, et al. Blood lead levels and death from all causes, cardiovascular disease, and cancer: results from the NHANES III mortality study. Environ Health Perspect 2006; 114(10): 1538–41

    PubMed  CAS  Google Scholar 

  3. EUROASPIRE Study Group. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. EUROASPIRE Study Group. European action on secondary prevention through intervention to reduce events [published erratum appears in Eur Heart J 1998; 19 (2): 356–7]. Eur Heart J 1997; 18 (10): 1569–82

    Google Scholar 

  4. Grundy SM, Brewer Jr JB, Cleeman JI, et al. American Heart Association, National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Definition of metabolic syndrome. Circulation. 2004; 109(3): 433–8

    Article  PubMed  Google Scholar 

  5. Wang TJ, Gona P, Larson MG, et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med 2006; 355(25): 2631–9

    Article  PubMed  CAS  Google Scholar 

  6. Danaei G, Lawes CM, Vander Hoorn S, et al. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 2006; 368(9548): 1651–9

    Article  PubMed  Google Scholar 

  7. Abegunde DO, Mathers CD, Adam T, et al. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370(9603): 1929–38

    Article  PubMed  Google Scholar 

  8. Boersma E, Keil U, De Bacquer D, et al. for the EUROASPIRE I and II Study Groups. Blood pressure is insufficiently controlled in European patients with established coronary heart disease. J Hypertens 2003; 21(10): 1831–40

    Article  PubMed  CAS  Google Scholar 

  9. Volpe M, Erhardt LR, Williams B. Managing cardiovascular risk: the need for change. J Hum Hypertens 2008 Feb; 22(2): 154–7

    Article  PubMed  CAS  Google Scholar 

  10. Volpe M, Alderman MH, Furberg CD, et al. Beyond hypertension toward guidelines for cardiovascular risk reduction. Am J Hypertens 2004; 17(11 Pt 1): 1068–74

    PubMed  Google Scholar 

  11. Alderman MH, Furberg CD, Kostis JB, et al. Hypertension guidelines: criteria that might make them more clinically useful. Am J Hypertens 2002; 15(10 Pt 1): 917–23

    Article  PubMed  Google Scholar 

  12. Volpe M, Tocci G. Joined-up cardiovascular risk management for the future: lessons learned from the ASCOT trial. Aging Clin Exp Res 2005; 17(S4): S46–53

    Google Scholar 

  13. Bensing J. Bridging the gap: the separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Counsel 2000; 39: 17–25

    Article  CAS  Google Scholar 

  14. Kannel WB. Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens 2000; 13(1 Pt 2): 3S–10S

    Article  PubMed  CAS  Google Scholar 

  15. Anderson KM, Odell PM, Wilson PW, et al. Cardiovascular disease risk profile. Am Heart J 1991; 121: 293–8

    Article  PubMed  CAS  Google Scholar 

  16. Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking and death from coronary heart disease: overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial (MRFIT) Research Group. Arch Intern Med 1992; 152: 56–64

    Article  PubMed  CAS  Google Scholar 

  17. Asia Pacific Cohort Studies Collaboration (APCSC). Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region. Circulation 2005; 112 (22): 3384–90

    Google Scholar 

  18. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–52

    Article  PubMed  Google Scholar 

  19. Emberson J, Whincup P, Morris R, et al. Evaluating the impact of population and high-risk strategies for the primary prevention of CVD. Eur Heart J 2004; 25: 484–91

    Article  PubMed  Google Scholar 

  20. Patrono C, García Rodríguez LA, Landolfi R, et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005; 353(22): 2373–83

    Article  PubMed  CAS  Google Scholar 

  21. Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update — consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation 2002; 106(3): 388–91

    Article  PubMed  Google Scholar 

  22. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14Suppl. 2: S1–113

    Article  PubMed  Google Scholar 

  23. Chobanian A, Bakris G, Black H, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–71

    Article  PubMed  CAS  Google Scholar 

  24. Williams B, Poulter NR, Brown MJ, et al. for the British Hypertension Society (BHS) Guidelines. Guidelines of management of hypertension: report of the fourth working party on British Hypertension Society — BHS IV. J Hum Hypertens 2004; 18: 139–85

    Article  PubMed  CAS  Google Scholar 

  25. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25(6): 1105–87

    Article  PubMed  CAS  Google Scholar 

  26. Grundy SM, Cleeman JI, Merz CN, et al. for the Coordinating Committee of the National Cholesterol Education Program (NCEP). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227–39

    Article  PubMed  Google Scholar 

  27. Dahlof B, Devereux RB, Kjeldsen SE, et al. for the LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For End-point reduction in hypertension (LIFE) study: a randomised trial against atenolol. Lancet 2002; 359: 995–1003

    Article  PubMed  CAS  Google Scholar 

  28. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) randomised trial. Lancet 2004; 363(9426): 2022–31

    Article  PubMed  CAS  Google Scholar 

  29. Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. for the INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290: 2805–16

    Article  PubMed  CAS  Google Scholar 

  30. Dahlof B, Sever PS, Poulter NR, et al. for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366(9489): 895–906

    Article  PubMed  Google Scholar 

  31. Mochizuki S, Dahlof B, Shimizu M, et al. Jikei Heart Study group. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet 2007; 369(9571): 1431–9

    Article  PubMed  CAS  Google Scholar 

  32. Patel A, ADVANCE Collaborative Group, MacMahon S, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370(9590): 829–40

    Article  PubMed  CAS  Google Scholar 

  33. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, part 1: prolonged differences in blood pressure — prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–774

    Article  PubMed  CAS  Google Scholar 

  34. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease, part 2: short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–839

    Article  PubMed  CAS  Google Scholar 

  35. Lewington S, Clarke R, Qizilbash N, for the Prospective Studies Collaboration, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13

    Article  PubMed  Google Scholar 

  36. Sheridan S, Pignone M, Mulrow C. Framinghan-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. J Gen Intern Med 2003; 18(2): 1039–52

    Article  PubMed  Google Scholar 

  37. El Fakiri F, Bruijnzeels MA, Hoes AW. Prevention of cardiovascular diseases: focus on modifiable cardiovascular risk. Heart 2006; 92: 741–5

    Article  PubMed  Google Scholar 

  38. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383–93

    Article  PubMed  Google Scholar 

  39. Sacks FM, Pfeffer MA, Moye LA, et al. for the Cholesterol and Recurrent Evens (CARE) Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9

    Article  PubMed  CAS  Google Scholar 

  40. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360 (9326): 7–22

    Google Scholar 

  41. Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than average cholesterol concentrations in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361:1149: 1158

    Google Scholar 

  42. Collhoun MH, Betteridge DJ, Durrington PH, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial. Lancet 2005; 364: 685–96

    Article  Google Scholar 

  43. Cholesterol Treatment Trialists’ Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78

    Google Scholar 

  44. Blood Pressure Lowering Treatment Trialists Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–45

    Google Scholar 

  45. Cannon CP, Steinberg BA, Murphy SA, et al. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006; 48(3): 438–45

    Article  PubMed  CAS  Google Scholar 

  46. Sesti G, Volpe M, Cosentino F, et al. Metabolic syndrome: diagnosis and clinical management, an official document of the Working Group of the Italian Society of Cardiovascular Prevention (SIPREC). High Blood Press Cardiovasc Prev 2006; 13(4): 185–98

    Article  CAS  Google Scholar 

  47. Elisaf M. The treatment of coronary heart disease: an update, part 1: an overview of the risk factors for cardiovascular disease. Curr Med Res Opin 2001; 17(1): 18–26

    PubMed  CAS  Google Scholar 

  48. Dominguez LJ, Galioto A, Ferlisi A, et al. Ageing, lifestyle modifications, and cardiovascular disease in developing countries. J Nutr Health Aging 2006 Mar-Apr; 10(2): 143–9

    PubMed  CAS  Google Scholar 

  49. Lloyd-Jones DM, Leip EP, Larson MG, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006; 113(6): 791–8

    Article  PubMed  Google Scholar 

  50. Pearson TA, Laurora I, Chu H, et al. The Lipid Treatment Assessment Project (LTAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000; 160: 459–67

    Article  PubMed  CAS  Google Scholar 

  51. Volpe M, Machado E. Treatment priorities and current prescribing patterns in hypertension: results of Global Research on Attitudes about hypertension and Stroke Prevention (GRASP), an international physician survey. Curr Med Res Opin 2004; 20(7): 1151–60

    Article  PubMed  Google Scholar 

  52. Erhardt LR, Pearson TA, Bruckert E, et al. Guidelines and their implementation: a discussion document focused on the best approaches to drive improvement. Vasc Dis Prev 2004; 1: 167–74

    Article  Google Scholar 

  53. Backlund L, Bring J, Strender LE. How accurately do general practitioners and students estimate coronary risk in hypercholesterolaemic patients? Prim Health Care Res Dev 2004; 5: 153–61

    Article  Google Scholar 

  54. Grover SA, Lowensteyn I, Esrey KL, et al. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ 1995; 310: 975–8

    Article  PubMed  CAS  Google Scholar 

  55. Putnam W, Twohig PL, Burge FI, et al. Evidence-based cardiovascular care: family physicians’ views of obstacles and opportunities. Can Fam Physician 2004; 50: 1397–405

    PubMed  Google Scholar 

  56. Backlund L, Skaner Y, Montgomery H, et al. The role of guidelines and the patient’s life-style in GPs’ management of hypercholesterolaemia. BMC Fam Pract 2004; 5: 3

    Article  PubMed  Google Scholar 

  57. Manuel DG, Lim J, Tanuseputro P, et al. Revisiting Rose: strategies for reducing coronary heart disease. BMJ 2006; 332(7542): 659–62

    Article  PubMed  Google Scholar 

  58. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program I: reduction in mortality of persons with high blood pressure including mild hypertension. JAMA 1979; 242: 2562–71

    Google Scholar 

  59. Tunstal-Pedoe H. The Dundee coronary risk-disk for management of change in risk factors. BMJ 1991; 303: 744–7

    Article  Google Scholar 

  60. Voss R, Cullen P, Schulte H, et al. Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Munster Study (PROCAM) using neural networks. Int J Epidemiol 2002; 31: 1253–62

    Article  PubMed  Google Scholar 

  61. Conroy RM, Pyorala K, Fitzgerald AP, et al. for the SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24(11): 987–1003

    Article  PubMed  CAS  Google Scholar 

  62. Giampaoli S, Palmieri L, Chiodini P, et al. Gruppo di Ricerca del Progetto CUORE. The global cardiovascular risk chart. Ital Heart J Suppl 2004; 5(3): 177–85

    PubMed  Google Scholar 

  63. D’Agostino RB, Russell MW, Huse DM, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J 2000; 139: 272–8

    PubMed  Google Scholar 

  64. Hobbs FDR, Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract 2002; 19: 596–604

    Article  PubMed  Google Scholar 

  65. Mancia G, Ambrosioni E, Rosei EA, et al. for the ForLife study group. Blood pressure control and risk of stroke in untreated and treated hypertensive patients screened from clinical practice: results of the ForLife study. J Hypertens 2005; 23(8): 1575–81

    Article  PubMed  CAS  Google Scholar 

  66. Murray CJ, Lauer JA, Hutubessy RC, et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk [published erratum appears in Lancet 2005; 366 (9481): 204]. Lancet 2003; 361(9359): 717–25

    Article  PubMed  Google Scholar 

  67. Ward S, Lloyd Jones M, Pandor A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007 Apr; 11(14): 1–160

    Google Scholar 

Download references

Acknowledgements

The authors wish to thank Giuliano Tocci, MD, in assisting with and preparing the manuscript. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Cardiology, II Faculty of Medicine, University of Rome “La Sapienza”, Sant’Andrea Hospital, Via di Grottarossa 1035-39, Rome, 00189, Italy

    Massimo Volpe

  2. IRCCS Neuromed — Pozzilli (Isernia), Isernia, Italy

    Massimo Volpe

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

    Leif R. W. Erhardt

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

    Bryan Williams

Authors
  1. Massimo Volpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leif R. W. Erhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryan Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Volpe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Volpe, M., Erhardt, L.R.W. & Williams, B. Cardiovascular Risk Management in Clinical Practice. High Blood Press Cardiovasc Prev 15, 9–16 (2008). https://doi.org/10.2165/00151642-200815010-00003

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00151642-200815010-00003

Key words

Search

Navigation