Reducing exposure to cardiovascular risk factors: the legacy of prevention

Over 50 years ago, the Framingham Heart Study investigators identified a range of common risk factors associated with atherosclerotic cardiovascular disease (ACVD) (1). Since then, several large-scale epidemiological studies conducted across all continents, such as the INTERHEART study, have linked ACVD risk factor exposure to cardiovascular outcomes (2). It is now commonly accepted that ACVD is mostly caused by measurable risk factors and the vast majority of these are modifiable, either via lifestyle modification, pharmacotherapy, or both. Of all ACVD risk factors, circulating cholesterol levels have perhaps received the most attention from not only the scientific and medical communities, but also by the media and the public alike. The association between cholesterol levels and ACVD has been studied for more than a century, with the cholesterol hypothesis having had its ups and downs [as recently summarized by Pedersen (3)].