[Cardiovascular risk factors--an integrated sympathetic viewpoint].

A large body of experimental and clinical data concerning the "classical cardiovascular risk factors" may be integrated into a unifying concept in which an increase in sympathetic activity and nutritional factors play a crucial role. The enhancement of sympathetic activity (e.g. as a consequence of psychosocial stress), induces--via direct and indirect mechanisms--activation of the renin-angiotensin-aldosterone system and the insulin axis. Balanced endothelial function may also be disrupted. Subsequently, these alterations lead to cardiovascular remodelling and development of the early stages of arteriosclerosis. Mechanical forces such as pressure and strain, and also mild hyperinsulinemia with secondary elevations in the LDL/HDL ratio further amplify these processes. Wrong nutrition, characterized by an elevated salt, sugar and fat intake, further stimulates these pathological events. The chain of events finally leading to the clinical manifestation of arteriosclerosis is certainly strongly based on, and modified by, a genetic predisposition. Cigarette smoking acts as a pulsatile, exogenous amplifier of the sympathetic nervous system. Furthermore, complex interactions of the various "hormonal risk systems", namely renin-angiotensin, insulin, and LDL/HDL cholesterol, have been observed at the cellular and molecular level. These interactions are integratively influenced by environmental and sympathetic factors. Therefore, a comprehensive approach should be incorporated into prophylactic and therapeutic strategies.