Risk factors for coronary heart disease in perspective. European intervention trials

Abstract

High blood pressure, smoking, and lipid abnormalities are the dominating risk factors for myocardial infarction and sudden coronary death. The influence of one risk factor is markedly modified by other risk factors. In countries with low cholesterol levels, myocardial infarction and sudden coronary death may be uncommon, whereas stroke becomes a relatively important sequelae in patients with severe hypertension. However, in most western countries myocardial infarction and sudden coronary death are more common than stroke, especially in patients with moderate blood pressure elevations. The results of intervention studies in coronary heart disease must be viewed in the light of the general risk factor pattern. The side effects of drugs should be considered since large-scale intervention is often required in order to save a relatively small number of lives. In those at high risk from cardiovascular complications, certain drugs are possibly more effective than others in preventing the more serious end points. The results of the Oslo trial are compared with those of the WHO Multifactorial Trial, which randomized factories to intervention and control (nonintervention) in England, Belgium, and Italy, and also with the Göteborg Multiple Risk Factor Intervention Trial. A comparison of the different trials might indicate caution with respect to drug treatment in people with moderately increased risk factors. The effect of the incidence of coronary heart disease in different trials correlated broadly with changes in risk factors. Varying effects on mortality and morbidity might be found for different treatment modalities.