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Epidemiologic studies have identified a number of important risk factors for CAD Most patients with coronary heart disease have some identifiable risk factor These include a positive family history (the younger the onset in a first-degree relative, the greater the risk), male gender, blood lipid abnormalities, diabetes mellitus, hypertension, physical inactivity and obesity, and cigarette smoking A large international epidemiologic study of myocardial infarction shows that most of the population-attributable risk is explained by eight factors: abnormal lipids, smoking, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, consumption of too few fruits and vegetables and too much alcohol, and lack of regular physical activity Smoking remains the number one preventable cause of cardiovascular disease worldwide Although smoking rates have declined in the United States in recent decades, 19% of women and 23% of men smoke According to the World Health Organization, 1 year after quitting, the risk of coronary heart disease decreases by 50% Various interventions have been shown to increase the likelihood of successful smoking cessation (see 1)

Centers for Disease Control and Prevention Overweight and Obesity: Home (wwwcdcgov/ncdphp/dnpa/obesity; accessed March 2007) Gardner CD et al Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial JAMA 2007 Mar 7;297(9):969 77 [PMID: 17341711] Howard BV et al Low-fat dietary pattern and risk of cardiovascular disease: the Women s Health Initiative Randomized Dietary Modification Trial JAMA 2006 Feb 8;295(6):655 66 [PMID: 16467234] Pearson TA et al; Centers for Disease Control and Prevention; American Heart Association Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association Circulation 2003 Jan 28;107(3): 499 511 [PMID: 12551878] Rosamond W et al Heart Disease and Stroke Statistics 2007 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation 2007;115:e69 71 [PMID: 17194875] Yusuf S et al; INTERHEART Study Investigators Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study Lancet 2004 Sep 11 17;364(9438):937 52 [PMID: 15364185]

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Although many risk factors for CAD are not modifiable, it is now clear that interventions such as smoking cessation, treatment of dyslipidemia, and lowering of BP can both prevent coronary disease and delay its progression and complications after it is manifest Treatment of lipid abnormalities delays the progression of atherosclerosis and in some cases may produce regression Even in the absence of regression, fewer new lesions develop, endothelial function may be restored, and coronary event rates are markedly reduced in patients with clinical evidence of vascular disease A series of clinical trials has demonstrated the efficacy of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) in preventing death, coronary events, and strokes Beneficial results have been found in patients who have already experienced coronary events (secondary prevention), in those at particularly high risk for events (diabetics and patients with peripheral artery disease), and those with elevated LDL cholesterol without multiple risk factors Benefits occurred regardless of age, race, or the presence of hypertension There is clear evidence that treatment with statins can prevent coronary events and stroke in patients without clinically manifest atherosclerosis (primary prevention) and LDL levels as low as 130 mg/dL It is also clear that for patients with vascular disease, statins provide benefit for those with normal cholesterol levels, and that more aggressive LDL lowering is associated with greater benefits The Heart Protection Study demonstrated that simvastatin 40 mg a day reduces vascular events by more than 20% in patients with prior myocardial infarction, stroke, peripheral vascular disease, or diabetes with total cholesterol levels as low as 135 mg/dL The treatment benefit was similar regardless of baseline LDL cholesterol, with equal benefit above or below 100 mg/dL This result

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