Related Resources • What is your risk? • More on risk factors

By DrRich

Dateline: 08/23/2003

Two articles appearing in the August 20 issue of the Journal of the American Medical Association show that fatal coronary artery disease is usually related to one or more of four well-known risk factors: high cholesterol, high blood pressure, cigarette smoking, or diabetes.  Both studies included thousands of patients from several large databases, and found that one of these four risk factors was present in between 87 to 100% of patients who died from coronary artery disease.

This finding is important, because conventional wisdom holds that only 50% of patients with coronary artery disease have one or more of the traditional risk factors.  In these very large, carefully done studies, the actual incidence is much higher.  In fact, it now appears that most patients who die from this disease can be "accounted for" by these traditional risk factors.

Recently, a lot of attention has been paid to "newer" risk factors - such as CRP, fibrinogen, lipoprotein (a), and homocysteine - largely because it has been believed that half the patients who go on to die from coronary artery disease would have been missed by traditional screening.  In truth, it seems, paying careful attention to traditional risk factors may be "good enough" for the vast majority of patients.  Unfortunately, it also seems clear that neither patients nor their doctors are addressing these traditional risk factors aggressively enough.  What we need, apparently, may not be new risk factors to worry about, but instead a renewed effort to manage the risk factors we've known about for decades.