Coronary heart disease: multiple risk factors and risk assessment

• In the landmark INTERHEART study of myocardial infarction, the ApoB/ApoA1 ratio was the most powerful predictor of risk of myocardial infarction. • In both men and women, potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction. • Stopping smoking by the age of 30 years eliminates the negative effect on an individual's life expectancy. Stopping at a later age is still beneficial. • Smoking, elevated blood pressure and dyslipidaemia account for about 75% of the variations in risk for future CHD events in people without diabetes. • Recent changes to PBS criteria for eligibility for subsidy of statins in people with diabetes acknowledge the high risk of CHD events in such patients. • GPs have a key role in reinforcing education about the need for early presentation to hospital if patients with known CHD experience 10 to 15 minutes of chest pain that might herald the onset of myocardial infarction. Provision of an action plan can be of assistance. • There is good evidence to support the use of aspirin (and clopidogrel in selected patients), statins, beta blockers and ACE inhibitors in patients with known CHD.