Vascular Disease Risks: Known and the Unknown?

Acute vascular events such as heart attacks, pulmonary embolisms, and stroke, are the leading causes of mortality and morbidity worldwide. Framingham heart study (FHS), developed by the National Heart Lung& Blood Institute (NHLBI), of the National Institutes of Health (NIH,) and the Boston University School of Medicine (BUSM), some 70 years ago, developed information about the modifiable risk factors, which promote the development of vascular diseases. Several studies have demonstrated that robust management of modifiable risk factors, leads to the decline in the deaths, due to vascular diseases. A comprehensive study done in 26 industrialized countries, has demonstrated a significant decline in deaths due to cardiovascular diseases (CVDs). The same study also noted that in spite of this observed decline in the CVDassociated deaths, there was an increase in the diabetes-related deaths. Another ongoing study by the National Health and Nutrition Education Survey (NHANES)of the USA, showed that 52% of adults with overweight, and 32% of adults with obesity, had no cardiac risk factors (CRFs), or only one CRF. Recent Scientific Statement by the American Heart Association, on the excess diabetes and heart disease in the South Asians living in the USA, also demonstrates the ethnic differences in the manifestation of specific risk factors, and their role in the precipitation of acute vascular events. These and other such observations, raise the question about the possible contribution of risks that are as yet unknown or less known, related to various ethnicity, demography, diet, physical activity, stress, and lifestyle. In this mini overview, we will touch upon the contribution of some known CRFs, speculate on the as yet unknow risks or relatively less known risks, and express our point of view on this very important topic.