Status of risk factors and their consideration in antihypertensive therapy.

Risk factors for cardiovascular disease include atherogenic personal attributes, living habits that promote them, signs of preclinical disease and host susceptibility. Atherogenic traits include the blood lipids, blood pressure and glucose tolerance. An increased low density lipoprotein cholesterol level is positively related, and an increased high density lipoprotein cholesterol level is inversely related, to cardiovascular disease incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes greatly. The impact of diabetes is greater for women than men and varies depending on the level of the foregoing risk factors. An atherogenic lifestyle is typified by a diet excessive in calories, fat and salt, sedentary habits, unrestrained weight gain and smoking. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 and in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk as are men married to women in white collar jobs. Preclinical signs of compromised coronary circulation include silent myocardial infarction, left ventricular hypertrophy on the electrocardiogram, blocked intraventricular conduction and repolarization abnormalities. An electrocardiogram obtained during exercise may elicit still earlier evidence. Measures of innate susceptibility include a family history, history of premature cardiovascular disease, diabetes, hypertension and gout. Optimal prediction of risk requires a quantitative combination of risk factors in multiple logistic risk formulations to identify high risk persons with multiple marginal abnormalities.