Kannel W B
Am Heart J. 1987 Jul;114(1 Pt 2):213-9. doi: 10.1016/0002-8703(87)90964-1.
Atherogenic traits, living habits, signs of preclinical disease, and susceptibility all contribute to cardiovascular disease. High low-density lipoprotein is positively related to coronary heart disease, and high high-density lipoprotein is inversely related. Systolic or diastolic hypertension at any age in either sex contributes powerfully. The impact of diabetes is greater for women and varies with the number of accompanying risk factors. High-normal fibrinogen values further escalate risk of these atherogenic factors. An atherogenic life-style is typified by a diet excessive in fat, calories, and salt; sedentary habits; unrestrained weight gain; and cigarette smoking. Moderate alcohol use may be beneficial. Use of oral contraceptives beyond age 35 years and in conjunction with cigarette smoking predisposes one to thromboembolism. Type A behavior carries an increased risk, and men married to more highly educated women and to women in white-collar jobs are more vulnerable. Signs of preclinical ischemia include silent myocardial infarction, left ventricular hypertrophy on ECG, blocked intraventricular conduction, and repolarization abnormalities. Measures of innate susceptibility include a family history of early cardiovascular disease. Quantitative combination of risk factors provides optimal prediction, including persons with multiple marginal abnormalities. Preventive management should also be multifactorial and requires a commitment to behavior modification and alteration in life-style.
致动脉粥样硬化特征、生活习惯、临床前疾病迹象和易感性均与心血管疾病有关。高低密度脂蛋白与冠心病呈正相关，而高高密度脂蛋白则呈负相关。任何年龄的男性或女性出现收缩期或舒张期高血压都有很大影响。糖尿病对女性的影响更大，且会因伴随的危险因素数量不同而有所变化。纤维蛋白原值略高于正常水平会进一步增加这些致动脉粥样硬化因素的风险。致动脉粥样硬化的生活方式表现为饮食中脂肪、热量和盐分过多；久坐不动；体重无节制增加；以及吸烟。适度饮酒可能有益。35岁以后使用口服避孕药且同时吸烟会使人易患血栓栓塞。A型行为会增加患病风险，娶受过高等教育的女性和从事白领工作的女性为妻的男性更容易患病。临床前缺血的迹象包括无症状心肌梗死、心电图显示左心室肥厚、室内传导阻滞和复极异常。先天易感性的指标包括心血管疾病早发的家族史。对危险因素进行定量综合可提供最佳预测，包括有多种临界异常情况的人。预防性管理也应是多方面的，需要致力于行为改变和生活方式的调整。
