Multiple risk factors for coronary artery disease: behavioral factors in preventive cardiology.

The prevention of ischemic heart disease requires intervention on the natural history of coronary artery disease (CAD). Because a variety of so-called risk factors influence that natural history, it is logical to consider modification of these risk factors as a way to prevent CAD. Although this approach is effective in both the primary and secondary prevention of CAD, this presentation will focus on behavioral intervention on multiple risk factors in the secondary prevention of CAD (i.e., after the initial cardiac event). A number of studies have suggested that lifestyle modification plays an important role in preventing CAD recurrence or death. Risk factors that require this modification of human behavior include: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, cigarette smoking, obesity, hypertension, physical activity and, although controversial, coronary prone personality. The assessment of these multiple factors can be performed in most acute care settings. The intervention on the factors requires a structured approach to the patient, taking advantage of the heightened awareness and concern at the time of a cardiac event. Often, several behaviors require modification simultaneously and other disciplines (behavioral medicine, nutrition, exercise physiology) are often useful when integrated into a single treatment plan. Involvement of the patient's social support network is essential. The effectiveness of the modification of each risk factor is assessed, as a means of recognizing behavior change as a way to prevent recurrence of the disease.