Starting early to control all risk factors in order to prevent coronary heart disease

  • McGill H
  • McMahan C
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Elevated blood cholesterol level was the first major contributor to
atherosclerosis to have its clinical manifestations established by
controlled clinical trials. More specific lipid conditions (high LDL-C
and low HDL-C) and nonlipid conditions (hypertension, smoking, obesity
and diabetes mellitus) have also been established by clinical trials or
extensive observational studies as contributors to atherosclerosis and
its sequelae. Programs directed at adults to control these conditions,
known as risk factors, have reduced the incidence of clinical disease.
However, both autopsy and cohort studies have demonstrated that
atherosclerosis begins in childhood, and its progression to clinically
significant lesions is associated with all the risk factors, lipid and
nonlipid, during the teenage and young adult years. Advanced plaques,
vulnerable. to changes that lead to rupture and thrombosis, are present
in the coronary arteries of some individuals by the age 40 years. These
observations indicate that risk-factor prevention should begin in
childhood. Furthermore, all risk factors are important and no risk
factor can be safely ignored, regardless of the presence or absence of
other risk factors. Promoting lifestyles in childhood that prevent all
the risk factors offers the best long range prevention strategy for
adult atherosclerotic disease.

Author-supplied keywords

  • Atherosclerosis
  • Coronary heart disease
  • Prevention
  • Risk factors
  • Youth

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  • Henry C. McGill

  • C. Alex McMahan

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