Cardiovascular diseases are responsible for nearly one of every two deaths in the United States, and have been estimated to cost more than $127 billion annually. Epidemiologic data have shown that persons with fewer or lower levels of the risk factors for cardiovascular disease are less likely to have a cardiovascular event. In addition, the greater the level of any single risk factor, the greater is the chance of incurring disease. Moreover, a combination of risk factors creates a synergistic effect, further increasing risk. Conversely, reducing the number and level of risk factors prevents death and disability from cardiovascular diseases.
This report addresses the management of patients with several cardiovascular risk factors, placing a special emphasis on hypertension and high blood cholesterol. Nonpharmacologic therapy, in the form of proper diet, exercise, and smoking cessation, is the foundation for management of both hypertension and high blood cholesterol. Clinicians should use these nondrug measures as definitive or adjunctive therapy. Pharmacologic agents can be very beneficial in managing the risks imposed by elevated levels of blood pressure or blood cholesterol. In selecting medications, it is important to weigh their benefits, costs, and potential untoward effects. Clinicians must consider these issues in managing patients with several risk factors but should not avoid managing any risk factor or quickly dismiss any particular mode of therapy simply because of the potential for adverse effects.