Perspectives: The burden of cardiovascular risk factors and coronary heart disease in Europe and worldwide

Cardiovascular disease (CVD) is estimated to be the leading cause of death and disability-adjusted life years lost worldwide being coronary heart disease the most prevalent form of heart disease. The underlying cause of most CVD is atherosclerosis, a process mainly governed by lifestyle factors. Several epidemiological studies have enabled the recognition of the major risk factors for CVD development, 'the so-called conventional risk factors'. Identification of such global risk factors have led, in turn, to the development of risk-prediction algorithms and cardiovascular risk models for men and women. Indeed, during the last years, there has been increasing credit of the importance of CVD in women accompanied by growing awareness of gender differences in natural history, preventive strategies, treatment, and prognosis of CVD. Classical risk factors, however, cannot fully explain the excess cardiovascular risk, and at least 25% of all future events occur in individuals with only one of the classical risk factors. This scenario has prompted the interest for discovering new risk factors. Time-trend analysis of surveys by the European Society of Cardiology (EUROASPIRE surveys) has reflected, however, that large proportions of European coronary patients are failing to achieve lifestyle, risk factor, and therapeutic targets for the prevention of CVD leaving room from improvement. Moreover, although overt CVD takes place during adulthood, lifestyle and dietary changes that have occurred over the last two decades support the need to instigate primary prevention measures during childhood as the best strategy to retard atherogenic processes.