We have reached a limit in our ability to reduce the incidence of coronary heart disease and cardiovascular disease utilizing the traditional evaluation, prevention, and treatment strategies for the top five cardiovascular risk factors—hypertension, diabetes mellitus, dyslipidemia, obesity and smoking. Statistics show that approximately 50% of patients continue to have coronary heart disease or myocardial infarction despite traditionally defined “normal” levels of these five risk factors. A more logical and in-depth understanding is required of these top five risk factors, including, the evaluation of 24-hour ambulatory blood pressure monitoring, advanced lipid profiles, dysglycemic parameters, visceral obesity, with the effects of adipokines and of the three finite vascular endothelial responses (which include inflammation, oxidative stress and immune vascular dysfunction) to the infinite number of insults. Understanding translational cardiovascular medicine to correlate the coronary heart disease risk factors to the presence or absence of vascular injury and disease with non-invasive vascular testing will allow for early identification, prevention and treatment of coronary heart disease and cardiovascular disease.
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