ABSTRACT
Cohort studies that started in the late 1960s discovered that, as an epidemic condition in Western countries, coronary heart disease (CHD) (the cardiovascular disease, CVD with the highest prevalence) is mostly due to environmental influences. These can be modified, so this finding opened the way for prevention.1 These studies developed the concept of risk factors. Three were consistently found to be predictors of CHD in different populations, that is, high
concentrations of serum cholesterol, high blood pressure and cigarette smoking. More than 30 years on, numerous other risk factors have been identified, for example, diabetes mellitus, a low serum concentration of high density lipoprotein cholesterol, a high circulating level of homocysteine and central adiposity-to name but a few. Risk factors interact synergistically. For instance, the excess risk of CHD death attributable to high cholesterol and high blood pressure is much greater for cigarette smokers than for non-smokers.
