[The Göttingen Risk, Incidence and Prevalence (GRIPS) study. Recommendations for the prevention of coronary heart disease].

The Göttingen Risk-, Incidence- and Prevalence Study (abbreviated GRIPS) consists of several epidemiological projects, among which project B is currently the most important one. Project B is a prospective cohort study, which was started in 1982 by a baseline investigation, including approximately 6000 men aged 40 to 60 years. Follow-up investigations were performed in 1985 and 1987 in order to record reasons of death and incidences of newly developed diseases. Further follow-up investigations are planned for 1990 and 1992. Until now incidence data of death and diseases are available for a 5-year observation period (January 1982-December 1986), and for more than 95% of the original study participants. The results clearly indicate that plasma levels of LDL-cholesterol, followed by plasma concentrations of total cholesterol and apoprotein B are the predominant predictors for the risk of coronary artery diseases (CAD; i.e. fatal and non fatal myocardial infarction as well as sudden coronary death and chronic coronary heart disease). Further significantly positive associations to the incidence of myocardial infarction (MI) were found for the following parameters: Systolic and diastolic blood pressure, family history of premature MI, cigarette smoking, plasma levels of triglycerides, VLDL-cholesterol and blood glucose. Plasma concentrations of HDL-cholesterol and apo A1 showed an inverse relationship to the MI incidence and--somewhat weaker--the same was true for the frequency of alcohol consumption and of physical leisure activity. Besides LDL-cholesterol, total cholesterol and apoprotein B the following parameters showed significantly positive associations to the risk of chronic coronary heart disease: Systolic as well as diastolic blood pressure and--to a lesser extent--the plasma levels of triglycerides, VLDL-cholesterol and blood glucose. An inverse relationship to the incidence rate of chronic coronary heart disease was found for HDL-cholesterol, apo A1 and the frequency of physical leisure activity. Based on the epidemiological results from GRIPS, additionally considering results from other epidemiologic studies and pathophysiological findings a diagnostic strategy was developed for the early recognition of patients at increased coronary risk. LDL-cholesterol is the most important variable in this diagnostic schedule but the coronary status and the individual profile of further risk factors (i.e. positive family history of premature myocardial infarction, hypertension, diabetes mellitus, cigarette smoking, increased plasma levels of triglyceride rich lipoproteins or Lp(a) as well as decreased plasma concentrations of HDL-cholesterol or apo A1) are additionally taken into account.