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Cardiovascular disease (CVD), or disease of the heart and blood vessels, continues to be a leading killer of men and women in the United States, accounting for close to 30 percent of all deaths annually. According to a leading researcher, CVD will remain a major cause of death unless Americans make a concerted effort to manage all of their risks.

"It's going to take a lot more than one small lifestyle change to reduce the toll of cardiovascular disease significantly," said Antonio M. Gotto Jr., MD, DPhil, dean and professor of medicine at the Weill Medical College of Cornell University in New York. "Although patients can't control their age, race and genetics, they can make positive changes that will affect their blood pressure, cholesterol levels, risk for diabetes, and weight, all of which contribute to cardiovascular disease."

Dr. Gotto spoke today at an American Medical Association media briefing, Cardiovascular Disease, in New York City.

Redefining Risk

The risks patients must consider and manage today differ substantially from the risks their parents and grandparents had to consider, said Dr. Gotto. At one time, cigarette smoking was a common practice and people were not as conscious of diet and exercise.

"Over the last 20 years, even the defining levels of cardiovascular risk factors have changed," explained Dr. Gotto. "We used to believe that an LDL, or bad cholesterol, level over 160 was too high, then it changed to 130 and then 100, as more clinical evidence became available. Now, based on the data, patients at very high risk for disease may need to keep their LDL under 70."

The same is true for high blood pressure. An "optimal" level was once considered less than 120/80 mm Hg. Now that same goal is considered "normal." A systolic blood pressure in the range of 120-140 mm Hg is now considered "pre-hypertension," a warning of blood pressure issues to come.

And the worldwide challenge of cardiovascular diseases is only likely to grow in the future. "As changes occur in the developing world, we're faced with an entirely new set of issues to combat in relation to cardiovascular disease, such as obesity and diabetes," Dr. Gotto added.

Management of all Risks

"The more risk factors someone has, the more likely he or she is to have cardiovascular disease," explained Dr. Gotto. "Having multiple risk factors exponentially increases your risk for having a heart attack or stroke. In cases where patients have two or more risk factors, the heart disease risk caused by the whole package is much worse than the risk associated with each individual risk factor."

In essence, this theory can also apply to prevention and management of risk factors; the more risk factors managed, the greater chance a patient can prevent heart disease.

"Research into risk has been extremely beneficial in giving physicians a better understanding of how they can help their patients," said Dr. Gotto. "The Diabetes Prevention Program demonstrated that several lifestyle changes, such as diet and exercise, can help prevent diabetes. But other studies, such as the Women's Health Initiative, suggest that making only one change, in this case a low-fat diet, isn't enough."

"Diet and exercise will only be effective if people also lower their blood pressure and cholesterol," he said. "Without management of all the issues related to one's cardiovascular health, it is very unlikely patients will reduce risk substantially and prevent disease."

Editor's Note: Dr. Gotto serves as a consultant for AstraZeneca Pharmaceuticals, Bristol Myers Squibb, Johnson & Johnson Merck, KOS Pharmaceuticals, KOWA, Merck, Merck/Schering-Plough, Novartis, Pfizer, and Reliant. He sits on the Board of Directors for Medtronic. Dr. Gotto has received an honorarium from the American Medical Association to speak at today's conference.