Introduction

Ezra A. Amsterdam, MD

The collection of papers on cardiovascular risk factors in this issue of CVIA was conceived by Dr. Richard Conti, editor in chief of the journal and I have been privileged to invite and work with the authors who have produced a highly informative and current critique of the major clinical issues in the field. Representing distinguished leaders in preventive cardiology in this country and Europe,their papers provide contemporary standards for the management of risk factors, illuminate controversial areas and consider future perspectives in this discipline so crucial to the reduction of cardiovascular disease burden.

In the first paper,Global Burden of Cardiovascular Disease, Estel and colleagues emphasize that cardiovascular disease is now the number one cause of mortality world-wide and places a high medical and socioeconomic burden on developing countries. The two chief contributors to cardiovascular disease are atherosclerosis and hypertensive heart disease. Because these risk factors are highly prevalent and responsive to therapy, they present a major opportunity for reducing the burden of cardiovascular disease.

The review by Eapen and co-authors,Primary Prevention of Cardiovascular Disease,reminds us of the dictum, “Prevention is better than cure”.They review current guidelines for the management of hypertension, cholesterol and lifestyle modi fication aimed at prevention of cardiovascular disease.Identification and control of cardiovascular risk factors requires cooperation between clinicians and patients.

In his review of smoking, the single most important, modi fiable risk factor for all morbidity and mortality, Luepker highlights the crucial role of clinicians in the prevention and cessation of this habit. Tobacco continues to confer its devastating in fluence on individual and public health as recent trends such as e-cigarettes gain popularity, especially with the younger populations. The potential for eliminating use of tobacco encompasses behavioral methods, self-help approaches, pharmacologic therapy and public health programs.

Wong addresses the proliferation of effective therapies by which clinicians can reduce LDL cholesterol and he considers the special role of PCSK9 monoclonal antibody preparations. Preliminary outcome data are promising in showing substantial decrease in cardiovascular disease events by these remarkable therapeutic agents. He also considers the important subject of non-statin therapy in the management of elevated LDL cholesterol.

We review the recent flurry of guidelines and provocative clinical trials addressing the management of hypertension. This highly prevalent and crucial risk factor is readily diagnosed and amenable to therapy in a majority of persons. Current controversies entail optimal blood pressure goals for reduction of cardiovascular disease. We address these issues from the perspective of JNC 7, JNC 8 and subsequent studies that consider traditional approaches and recent, compelling results of the SPRINT investigation.

Rozanski explores the burgeoning field of behavioral cardiology which is based on the strong link between psychosocial risk factors and cardiovascular disease. His innovative studies have furthered our understanding of the adverse cardiovascular impact of negative psychosocial factors and their physiologic mechanisms. He also considers practical methods for managing psychosocial risk factors.

Biasucci and Rosa point out that human gut microbiota have been recently investigated as one of the major contributors to host metabolism. Its imbalance and alterations have been linked to several intestinal and metabolic derangements such as metabolic syndrome. They describe specific mechanisms involved in the relationship between gut microbiota and atherosclerosis and consider the potential of novel therapeutic targets to reduce the burden of cardiovascular disease.

Mehta and colleagues call attention to the major role of in flammasomes in mediating atherogenesis.Recognition of in flammasomes has improved our understanding of the relationship between in flammation and cholesterol metabolism. They focus on the role of NLRP3 in flammasome in atherosclerosis and discuss potential therapeutic targets in the in flammasome pathway.