International Task Force for Prevention of
Coronary Heart Disease

CORONARY HEART DISEASE: REDUCING THE RISK

1.7 The concept of global risk

One of the most significant findings to emerge from large prospective epidemiological investigations such as the Framingham study, the Multiple Risk Factors Intervention Trial and the Münster Heart Study (PROCAM) is that a person`s risk of developing coronary heart disease rarely depends on a single risk factor, such as an isolated elevation of LDL-cholesterol. Such uncommon cases usually reflect a major genetic defect such as a mutation in the LDL receptor. In most cases, risk is determined by a synergy between two or more risk factors, each often of only mild degree. The inherited aspect of risk factors is most often a number of genes of small effect (polygenes), and these interact with environmental factors. It is important to realise that the combined risk conferred by multiple risk factors can be considerably greater than the sum of the individual risks; their joint effect on global risk is greater than would be expected from a simple addition of each risk