Grouping of risk factors

In the CB Heart Project – the multifactorial preventive community study which is the subject of this issue –hypercholesterolemia, hypertension, and cigarette smoking are considered the major risk factors for premature coronary heartdisease. Overweight, sedentary living, and risk augmenting “x-factors” (such as ischemic ECG findings) have been added to thistriad. The population under study (general population aged 35-49 yrs of two towns and teachers of Rotterdam aged 20-39 yrs) wasdivided into four groups according to the scores of risk factors: “low risk” (A), “borderline risk” (B), “high risk” (C), and “very highrisk” (D). Persons belonging to group D (0.7%) were referred to the general practitioner because they were potentially ill orrequired thorough medical examination. Persons with “high risk” (group C) were those with one or more “elevated” risk factors,and those with two or more “borderline” risk factors plus a risk augmenting “x-factor”. The cut-off points for “elevated” were:serum cholesterol ? 7.3 mmol/1, blood pressure ? 160 and/or ? 105 mm Hg, and smoking ? 25 cigarettes/day. More than two-fifths (44 %) of the male population, mostly aged 40-49 years, belong to the “high risk” group C. Thecorresponding figure for the female general population is 30%. Differentiation of group C in the male general population shows:within the group with 1 “elevated” risk factor the proportion of smoking is highest (55%), within the 2 risk factor group the mostfrequent combination is “elevated” cholesterol and cigarette smoking (48%), and within the 3 risk factor group the most frequentcombination is “elevated” blood pressure, cholesterol, and cigarette smoking (87%). In the female general population these proportions are: 16, 28 and 79% respectively. In this group, not smoking (16%), but cholesterol (36%) is the most frequent single“elevated” risk factor. The prevalences of ECG signs of possible and probable ischemia in persons belonging to the “high risk”group in the general population are 12% in women and 8% in men. The high percentage (25%) of the male general population with three or more “elevated” risk factors (and a further 14% withtwo, and 6% with one “elevated” risk factor), notwithstanding the conservative cut-off points, is alarming. The correspondingproportions in teachers of Rotterdam are 5, 4, and 5%. This relatively favourable risk pattern observed amongst teachers showsthe way the general population of The Netherlands has to go in the near future.