Age as a modifiable risk factor for cardiovascular disease

Abstract

Cardiovascular disease is set to become the major cause of death worldwide. As its clinical consequences increase, so do the benefits of prevention. Age is not considered to be a modifiable risk factor but, unfortunately, it outranks all those that are—eg, lipids, blood pressure, and smoking—as a predictor of clinical events. If so, a tight limit exists on how much prevention can be achieved. But is conventional wisdom correct? Are all the effects of age immutable? And how do we deal with the dilemma that atherosclerosis is often well underway before middle age whereas clinical complications are common only after middle age? Should pharmacological prevention be delayed until just before death and myocardial infarction accelerated—a position major guideline groups have taken—or should we intervene earlier?