Lipoproteins and Apolipoproteins in the Prediction of Coronary Artery Disease

Abstract

Atherosclerotic cardiovascular disease is the leading cause of death and also the most frequent cause of early invalidity in most European countries. Clinical conditions such as coronary heart disease (angina pectoris, myocardial infarction, acute cardiac death), cerebrovascular insufficiency (apoplexy), and peripheral arterial occlusive disease (intermittent claudication, gangrene) become manifest following decades of asymptomatic development of atherosclerotic vascular stenosis. In evaluating coronary risk there is a distinction made between primary risk factors (hypercholesterolemia, nicotine abuse, hypertension) and secondary risk factors (diabetes mellitus, obesity, lack of physical activity). The primary risk factors are individually capable of producing clinical complications of atherosclerotic vascular disease. Secondary risk factors, as a general rule, evoke clinical complications only in conjunction with one or more other factors. Individual risk factors should not be viewed as isolated in the course of a disease, since they frequently occur in combination. The incidence of cardiovascular disease increases cumulatively with the presence of multiple risk factors. The concept of a multifactorial basis for the origin of atherosclerotic vascular disease is principally derived from the findings of epidemiological studies. It has been demonstrated quite convincingly in the example of acute cardiac death that risk factors can be identified in the overwhelming majority of cases and that individual risk factors are interrelated.