This volume is a collection of the most significant contributions to the 4th International Symposium on MULTIPLE RISK FACTORS IN CARDIOVASCULAR DISEASE: STRATEGIES OF PREVENTION OF CORONARY HEART DISEASE, CARDIAC F AlLURE, AND STROKE held in Washington, D. C. in April 1997. The meeting focused on the risk factors for cardiovascular disease and their interactions. The need for this symposium is based on the epidemiological, clinical, and biological evidence that individuals from industrialized countries often possess two or more risk factors which synergistically increase the global risk profile. This has become more evident in recent years with the increase in life expectancy of populations in the industrialized countries. The evidence that a combination of risk factors confers a very high risk of developing cardiovascular diseases, is of pivotal interest in the process of detection of patients who will benefit the most from pharmacological treatment. Many recent epidemiological data identifying the intrinsic and environmental factors contributing to the development of atherosclerosis are discussed. These results, in parallel with basic and clinical research, underline atherosclerosis as a complex and multifactorial process involving the influences of lipids, including lipoprotein subfractions, blood pressure rheologic forces, carbohydrate tolerance, and thrombogenic factors, including fibrinogen, tissue factor, PAl-I, and homocysteine. Furthennore, the risk associated with anyone of these risk factors varies widely depending on the level of the associated atherogenic risk factors. Hyper cholesterolemia and hypertriglyceridemia, for instance, are more common than would be expected by chance among hypertensive patients.

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I. Plasma Lipids and Lipoproteins.- New Insights into the Role of HDL in the Development of Cardiovascular Disease.- Mechanisms of the Hypolipidemic Action of Fibrates.- Lipid Lowering Drugs and the Arterial Wall.- Perspectives on Lipid-Lowering Therapy: Past and Present.- II. Coagulation, Fibrinolysis, and Platelet Inhibition.- Role of the Fibrinolytic and the Coagulation System in the Formation and Disorders of Blood Vessels.- Evolving Understanding of Coronary Thrombosis and New Insights into Therapeutic Strategies.- Platelet Activation and Carotid Arterial Atherothrombosis.- III. Emerging Risk Factors for Cardiovascular Disease.- Tissue Factor and the Regulation of Arterial Thrombosis.- Fibrinogen: Risk Factor or Risk Marker?.- PAI-1 and the Risk of Cardiovascular Disease.- Plasma Homocyst(e)ine [H(e)] and Arterial Occlusive Diseases: Gene-Nutrient Interactions.- IV. Risk Factors and Intervention: National Initiatives.- The Role of Social and Psychoemotional Factors in the Development of Cardiovascular Disease: The Experience in Eastern European Countries.- European Action on Secondary Prevention.- Cardiovascular Risk Factors in Normotensive and Hypertensive Egyptians: Preliminary Results, Egyptian National Hypertension Project (NHP).- V. LDL Oxidation, Antioxidants, and Atherosclerosis.- Lipid Deposition and Oxidation in the Evolution of the Atherosclerotic Lesion: Lessons Learned from Hypercholesterolemic Animal Models.- Oxidative Modification of LDL and Atherogenesis.- Dietary Antioxidants and Cardiovascular Disease.- Is Antioxidant Status a Risk Factor?.- VI. Diabetes.- Diabetes and Atherosclerosis: Risk Factors and Clinical Trials.- Insulin Resistance: What, Why, and How.- Diabetes.- Dyslipidemia, Diabetes, and Cell Adhesion Molecules.- Novel TherapeuticApproaches to Insulin Resistance/Diabetic Dyslipidemia.- VII. Genetic Determinants of Cardiovascular Disease.- Hypertension and Thrombosis, Genetic Determinants of Cardiovascular Disease.- Lipoproteins and Cardiovascular Risk. From Genetics to Prevention of Coronary Heart Disease.- Obesity and Diabetes.- Clustering of Cardiovascular Risk Factors.- VIII. Inflammation and Cardiovascular Disease.- Neutrophil-Endothelial Cells Cooperation in the Handling of Leukotrienes: Role in Coronary Inflammation.- Integrin Expression and Macrophage Resistance to Apoptosis in Atherosclerosis.- IX. From Cholesterol to Cardiovascular Events, Where is the Bridge?.- Effect of Statins Beyond Lowering Cholesterol: Where Do We Stand?.- Lessons from Clinical Trials: LCAS and Other Studies.- Improving the Cost Effectiveness of Lipid Lowering Therapy in Coronary Heart Disease Prevention.- X. Lifestyle and Cardiovascular Disease.- Diet and Cardiovascular Disease.- Alcohol and Coronary Heart Disease: A Comparison of Ecologic and Non-Ecologic Studies.- Preventing Cardiovascular Disease: Effective Smoking Cessation Strategies for the Busy Clinician.- XI. Multiple Risk Factors and Cardiovascular Disease.- Risk Factors for Cardiovascular Disease and the Endothelium.- Epidemiology of Risk Factor Clustering in Elevated Blood Pressure.- Hypertension and Coronary Heart Disease Risk Factor Management.- Global Risk Management: New Strategies for Implementation.- XII. Cardiac Failure.- Sudden Cardiac Death in Heart Failure.