Risk Factors and Primary and Secondary Prevention of Coronary Heart Disease
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1 Special Issue Risk Factors and Primary and Secondary Prevention of Coronary Heart Disease Shung Chull Chae, M.D. Department of Internal Medicine / Division of Cardiology Kyungpook National University College of Medicine & Hospital E mail : scchae@knu.ac.kr Abstract Atherosclerosis is a major cause of coronary heart disease. Many clinical characteristics and laboratory parameters are known to be related with atherosclerosis and/or coronary heart disease, either epidemiologically or causally. Although the risk to develop cardiovascular disease (CVD) is on a continuum, the risk factor modification was traditionally categorized into primary or secondary prevention based on the presence of clinical CVD. Mega trials of the primary and secondary prevention have been reported rendering the previous recommendations obsolete. Several guidelines, including the Adult Treatment Panel III, JNC VII, and the European and British guidelines, were recently released for dyslipidemia and hypertension. Global assessment of CVD risk with multiple risk factors, rather than risk assessment by an individual risk factor is adopted in all of the current guidelines. Absolute risk levels are used for setting of a target level of a given risk factor and for selection of intervention modalities. Complete cessation of smoking, control of dyslipidemia, hypertension, diabetes, and body weight, moderation of alcohol consumption, and guided use of certain medications have been recommended. The hormone replacement therapy was believed to be cardioprotective and recommended for the primary and secondary prevention of coronary heart disease. However, it is no longer recommended for the purpose of the prevention of coronary heart disease. The concept of the more, the better is recommended for exercise. Guidelines are ever so changing! Keywords : Atherosclerosis; Coronary heart disease; Primary prevention; Secondary prevention; Risk factor 704
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