Main description:

This book includes the most significant contributions of the First International Symposium on "Multiple risk factors in cardiovascular disease", chaired by Professors A. V. Chobanian (Boston), A. M. Gotto Jr. (Houston), c. Lenfant (Bethesda), R. Paoletti and A. Zanchetti (Milan), held in Washington DC, 10-12 December 1990, which focused on the risk factors for cardiovascular disease and their interactions. The need for this symposium is based on the epidemiological evidence that individuals from industrialized countries often possess two or more risk factors which synergically increase the global risk profile. The evidence that isolated vascular risk factors are not commonly found in high risk patients but more often a combination of risk factors are detected, is highlighted. Many recent epidemiological data identifying the intrinsic and environ mental factors contributing to the development of atherosclerosis are discussed. These results, in parallel to basic and clinical research, underline how atherosclerosis is a complex and multifac torial process involving the influences of lipid deposition, blood pressure, rheologic forces, carbohydrate tolerance, and thrombogenic factors (fibrinogen and platelets). Atherosclerosis is markedly accelerated by other risk factors, more so in the presence of concomitant hypercholes terolemia, hypertension, diabetes, upper body obesity. Furthermore, the risk associated with anyone of these risk factors varies widely depending on level of the associated atherogenic risk factors.

Contents:

1. Individual risk factors for cardiovascular disease.- 2. The lipid hypothesis: is it the only cause of atherosclerosis?.- 3. Life styles and life style related major risk factors: their combined impact in producing epidemic cardiovascular disease, and the potential for prevention.- 4. The role of genetics as a risk factor in cardiovascular disease.- 5. Multiple risk factors in an Italian population in the 1980's: the Gubbio study.- 6. Cardiovascular risk factors in older individuals.- 7. Retardation and regression of coronary atherosclerosis: fact or fiction?.- 8. Cardiovascular risk factors and intervention in children.- 9. Should (nearly) every postmenopausal woman be treated with estrogen to prevent heart disease?.- 10. Role of insulin resistance in human disease.- 11. The effects of insulin on the cardiovascular system.- 12. Insulin - a risk factor for cardiovascular disease?.- 13. Hypertension and dyslipidemia in high risk families.- 14. Hypertension and aging induce similar changes in molecular, cellular, and connective tissue responses of the arterial wall.- 15. Plasma renin as a risk factor for heart attack and stroke in hypertension.- 16. Cardiovascular risk factor profile of hypertension: therapeutic approaches.- 17. Specific antihypertensive therapy: an achievable goal?.- 18. Effects of blood pressure control on the prevention of cardiovascular complications in older hypertensives.- 19. Calcium channel blockade and coronary vasomotility in hypertension.- 20. Antihypertensive agents and cardiovascular risk.- 21. Hypertension and atherosclerosis: role of calcium antagonists as antiatherogenic agents with an emphasis on clinical trials.- 22. Stepped-care versus individualized antihypertensive treatment in the 1990's.- 23. Body fat distribution and cardiovascular disease.- 24. Lipoprotein(a) as an athero-antifibrinolytic risk factor.- 25. Aspirin in the secondary prevention of cardiovascular disease.- 26. Interactions of atherogenic lipoproteins with endothelium and blood cells.- 27. Left ventricular mass as a measure of preclinical disease in patients with hypertension.- 28. Increased triglyceride levels and cardiovascular disease.- 29. Whither triglycerides in the cholesterol campaign.- 30. Plasma triglyceride and coronary heart disease.- 31. Role of high density lipoprotein in plasma lipid transport: is cholesterol efflux from cells coupled to lipolysis of triglyceride-rich lipoproteins?.- 32. Non-pharmacological measures to improve HDL-cholesterol and plasma triglyceride levels.- 33. Drugs affecting HDL/triglyceride levels.- 34. Fibrates and reversal of atherogenic particles.- 35. HDL cholesterol: methodological considerations and laboratory performance.