Coronary Disease Risk Factors: A Population View

Abstract

The evidence is strong that levels of blood cholesterol, arterial blood pressure and cigarette smoking influence the risk of coronary atherosclerosis and heart disease (CHD). The inference that they are causal is based on the strength, consistency and independent predictive power of the associations found in populations and the congruence of the epidemiological with clinical and experimental evidence. Most informed investigators have accepted this evidence as providing a strong rationale for preventive practice and public policy. Nevertheless, much work remains for effective translation of this evidence into public health action. In addition, much detail remains to be elaborated in the risk factor-disease relationships and the mechanisms of their causal effects. Moreover, new findings beg explanation, such as the possible inverse association between an individual’s blood lipoprotein levels and risk of colon cancer, and the varied relationship of obesity to cardiovascular (CVD) disease risk. We believe that we can most constructively treat here those issues which are inconsistent or controversial. Therefore, we will consider the shape of the risk factor relationships to disease, certain departures from prediction, touch on underlying mechanisms, and discuss the implications of these newer findings for research and strategies of primary prevention.