Based on the results of the Prospective Cardiovascular Miinster Study (PROCAM-Trial), new possibilities are shown which permit the recognition of a coronary risk or the prediction of the likelihood of amyocardial infarction. Practical problems in the classification oflipid metabolismdisordersare discussed as well as up to date possibilities for special diagnostic procedures.
Atherosclerotic cardiovascular disease is the leading cause of death and also the most frequent cause of early invalidity in most European countries. Clinical conditions such as coronary heart disease (angina pectoris, myocardial infarction, acute cardiac death), cerebrovascular insufficiency (apolexy) and peripheral arterial occlusive disease (intermittent claudication, gangrene) become manifest following decades of asymptomatic development of atherosclerotic vascular stenosis. In evaluating coronary risk there is a distinction made between primary risk factors (hypercholesterolemia, nicotine abuse, hypertension) and secondary risk factors (diabetes mellitus, obesity, lack of physical activity). The primary risk factors are individually capable of producing clinical complications of atherosclerotic vascular disease. Secondary risk factors, as a general rule, evoke chical complications only in conjunction with one or more other factors. Individual risk factors should not be viewed as isolated in the course of a disease, since they frequently occur in combination. The incidence of cardiovascular disease increases cumulatively with the presence of multiple risk factors. The concept of a multifactorial basis for the origin of atherosclerotic vascular disease is principally derived from the findings of epidemiologcal studies. It has been demonstrated quite convincingly in the example of acute cardiac death that risk factors can be identified in the overwhelming majority of cases and that individual risk factors are interrelated.
Without drawing attention from the importance of other risk factors, particular emphasis must be placed on the close correlation between hypercholesterolemia and atherosclerosis. Supported by the results of epidemiological studies as well as clinical findings in addition to the results of animal experiments, there can be no doubt about the role of cholesterol in the pathogenesis of coronary heart disease. The cornerstone of this viewpoint is the dose-response relationship between serum cholesterol level and the risk of coronary heart disease, as determined in various epidemiologxal studies. Suitable preventive measures and expert diagnosis, i. e. recognition of high risk patients as well as application of modem treatment procedures are equally important in order to reduce morbidity and mortality due to coronary heart disease. On all of these aspects there have recently been developments which are referred to below.