oa SA Pharmaceutical Journal - Primary prevention of atherosclerotic vascular disease : clinical
Atherosclerosis is a process that starts early in life and progresses silently and slowly for decades, usually only manifesting clinically in middle age.
The main objectives of primary prevention are to reduce morbidity, to improve quality of life and to increase life expectancy. There is growing evidence that lifestyle changes and primary risk factor modification can reduce both morbidity and mortality.
The major risk factors for atherosclerosis are age, family history, dyslipidaemia, cigarette smoking, hypertension and diabetes. These risk factors rarely occur in isolation.
A low level of HDL cholesterol is an independent risk factor for future cardiovascular events. Low HDL is defined as less than 1.03 mmol/l in men and less than 1.30 mmol/l in women.
Clustering of CAD risk factors such as hypertension and dyslipidaemia may begin in childhood, indicating a need for screening for cardiovascular risk early in life.
The major finding of prevention trials with cholesterol-lowering agents is an early and dramatic reduction in clinical events in treated patients who have a baseline LDL-cholesterol > 4.0 mmol/l; an LDL cholesterol level that was previously considered normal that did not warrant drug therapy.
Lifestyle interventions are crucially important in the control of obesity, dyslipidaemia and diabetes.
Novel risk factors are emerging which may prove to be the key to improving the current risk estimation approach which is lacking in certain respects.
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