August 20, 2003

Physicians and researchers should focus on the four risk factors responsible for nearly 90 percent of coronary heart disease (CHD), according to Dr. John Canto of UAB (University of Alabama at Birmingham). Canto and Dr. Ami Iskandrian co-wrote an editorial in this week’s issue of the Journal of the American Medical Association.

Close to 100 percent of those who die from coronary heart disease have at least one of four major risk factors, according to a study in the same issue. The four conventional risk factors are smoking, diabetes, high blood pressure and high cholesterol. In a third report, authors conclude that emerging new risk markers such as inflammatory proteins called C-reactive protein, Lipoprotein-A and homocysteine, do not add as much predictive value as the four major ones.

Collectively, the three studies challenge longstanding claims that only half of CHD is caused by the four conventional risk factors.

“These articles have enormous public health implications for targeting a large segment of the population at risk of developing CHD,” Canto and Iskandrian wrote. “The studies emphasize that to reduce the burden of cardiovascular disease, physicians should have even greater vigilance in identifying conventional CHD risk factors and must redouble efforts to control them effectively.”

“If we just focused on treating and preventing the four major risk factors, we could put a substantial dent in the toll coronary heart disease is taking on this country,” Canto said.