Personal medical decision making : for prevention of a first cardiovascular event

Abstract

Atherosclerotic cardiovascular disease (CVD) remains the leading cause of mortality worldwide, accounting for approximately 30% of total mortality. In the Netherlands, the total number of coronary attacks a year is estimated to be 82,100: 6.13 per 1,000 men and 3.91 per 1,000 women. Approximately 35,600 experience a stroke each year: 2.12 per 1,000 men vs. 2.23 per 1,000 women. The majority of CVD events comprises first events. According to American Heart Association statistics, of all coronary attacks approximately 60% is a primary event, whereas 75% of all strokes are first strokes. CVD is a multi-factorial disease par excellence, with a number of modifiable physiological risk factors such as high blood pressure, high total cholesterol, high blood glucose, and high bodymass index. Also modifiable behavioral factors play a causal role and include increased alcohol use, (second-hand) tobacco smoking, unhealthy diet and physical inactivity. The risk of disease can potentially be diminished through the modification of these risk factors in individuals without a history of CVD.