RISK-FACTORS IN ARTERIOSCLEROSIS AND CARDIOVASCULAR-DISEASE WITH SPECIAL EMPHASIS ON CIGARETTE-SMOKING

Large international differences in mortality from the atherothrombotic diseases, notably coronary heart disease, suggest that differences in environment and lifestyle may be important. Cholesterol is the lipid characteristically found in the atheromatous plaque. Serum cholesterol concentration is invariably higher in populations with high rates of coronary heart disease than in populations where the prevalence is low. The serum cholesterol level is probably determined by the amount of fat habitually consumed and only infrequently by genetic factors. Arterial hypertension and heavy cigarette smoking powerfully increase the risk of coronary heart disease in the presence of hypercholesterolemia. The mechanism whereby cigarette smoking aggravates and accelerates atheropoiesis is unknown, but carbon monoxide and mobilization of catecholamines are probably implicated. The prevalence of the atherothrombotic diseases and of their ischemic complications can, in theory, be reduced by controlling hypercholesterolemia and hypertension and eliminating cigarette smoking. © 1979.