ABSTRACT
The management of cardiovascular risk factors is an integral part of the optimal care of the patient with established cardiovascular disease or at high risk for the development of this disease. Improvement of levels of risk factor management will require a coordinated effort by cardiovascular specialists, primary care physicians, and other health professionals such as nurses, nutritionists, hospitals, health care systems, and third-party payors. The cardiovascular specialist is uniquely positioned to provide leadership in risk factor management by virtue of the specialist’s role in giving care and advice to those patients with established atherosclerotic disease who are at the very highest risk of disability and death due to these risk factors. The 27th Bethesda Conference of the American College of Cardiology was convened (Table 1) with the specific goal of clarifying the role of the management of risk factors in the care of high-risk patients (Tables 2 and 3) (1). Specifically, the rationale for heightened attention to cigarette smoking, lipid disorders, hypertension, thrombotic diathesis, and other risk factors in the high-risk patient was developed, allowing for specific recommendations for case management and for organizational strategies to assure the optimal provision of these services. At the same time, recommendations about screening and case management in low-risk patients emphasized the need for assessment of cost-effectiveness in patients who may or may not incur benefit from interventions
Valentin Fuster, MD, PhD (Conference Co-Chair) Thomas A.Pearson, MD, PhD (Conference Co-Chair)
with high cost or sizable risks of management intensity with cardiovascular risk. Our understanding of the pathophysiology of atherosclerosis and the role of risk
factors in this disease process has drastically changed in the last few years (Task Force 1) (2). This understanding should lead to continued advances in control of the disease and its sequelae. However, current evidence from basic and clinical studies provides a strong rationale for the control of risk factors as an essential strategy to normalize endothelial function; halt the progression of coronary atherosclerosis; and prevent the instability, rupture, and thrombosis of atherosclerotic plaques.
