ABSTRACT
The development of cardiovascular disease can be understood in terms of exposure to risk factors. These damage the vasculature and, if exposure is chronic, may overwhelm natural repair mechanisms and set in motion processes that ultimately lead to the catastrophic consequences of arterial occlusion, including stroke and heart attack. Risk factor exposure may be external, as with cultural, lifestyle, and environmental influences, or internal, according to the body’s physiologic or biochemical characteristics. Sex hormone levels can profoundly influence the latter. External and internal risk factor relationships can interact and, in men, these interactions and interrelationships are exemplified by the changes in risk factor status that accompany aging.
Cigarette smoking, hypertension, and hypercholesterolemia are the classic risk factors for cardiovascular disease. Exposure to tobacco imposes the greatest coronary heart disease burden worldwide,1 whereas elevated blood pressure is an especially strong indicator of risk of cerebrovascular disease. Each of these risk factors damages the arterial endothelium, but how this damage progresses depends on local conditions and intensity of exposure. For example, cholesterol can be deposited in the subendothelial
