Definition of new targets in cardiovascular prevention from young into old age

In the perception of the public and many health workers, cardiovascular disease and mortality strike at old age so that borderline elevated cardiovascular risk factors do not require intervention in young or middle-aged people. The report by Thomas and colleagues disproves this attitude of complacency. Among French patients aged 18–55 years, cardiovascular and coronary mortality were minimal if systolic pressure and serum total cholesterol were below 130 mmHg and 200 mg . dl , respectively. In men, after adjustment for other cardiovascular risk factors including age and smoking habits, the risk of coronary mortality rose threefold if systolic pressure was high–normal (130–139 mmHg). In the presence of hypercholesterolaemia ( 240 mg . dl ), the risk ratio further increased to 10 or 17 depending on whether systolic pressure was mildly (140– 159 mmHg) or more severely ( 160 mmHg) elevated. Similar trends, albeit less strong, were observed in women. The findings of Thomas and colleagues are in line with recent publications from the Framingham Heart Study. These investigators reported a continuous increase in cardiovascular risk with higher systolic pressure. As compared with optimal blood pressure, high–normal systolic pressure was associated with a risk factor adjusted hazard ratio for cardiovascular disease of 2·5 in women and 1·6 in men. According to the guidelines of the World Health Organization and the International Society of Hypertension optimal blood pressure levels are less than 120 mmHg systolic and 80 mmHg diastolic, while high–normal blood pressure ranges from 130 to 139 mmHg systolic and from 80 to 85 mmHg diastolic. One decade ago, the Multiple Risk Factor Intervention Trial demonstrated a strong graded relationship in middle-aged men (35–57 years) between mortality from coronary heart disease and systolic pressure above 110 mmHg, diastolic pressure above 70 mmHg and serum cholesterol levels above