The emerging risk factors for cardiovascular disease: a review of the epidemiologic evidence for lipoprotein(a), homocysteine, and fibrinogen

Appropriate correction of cardiovascular risk factors is a mainstay of the treatment of patients that have developed or might develop cardiovascular disease. In addition to classical risk factors, such as hypertension, smoking, dyslipidemia, diabetes, obesity, and sedentary life, epidemiological research has identified a number of additional conditions that are associated with a greater risk of cardiovascular disease. In fact, a substantial percentage of patients who develop cardiovascular events do not have any of the classical risk factors. Over the past thirty years, effective intervention in the treatment of hypertension, dyslipidemia, and diabetes has reduced remarkably cardiovascular morbidity and mortality, but the incidence of coronary artery disease and stroke remains unacceptably high and cardiovascular diseases are still the leading cause of death in the Western world. New cardiovascular risk factors are likely to give substantial contribution to this scenario and it could be easily anticipated that this contribution will become more evident in the upcoming years. This is why physicians who operate in the field of cardiovascular medicine and deal with problems related to cardiovascular prevention should be aware of these emergent risk factors, evaluate them accurately in their patients, and treat them appropriately. This review will summarize the literature supporting the role of lipoprotein(a), homocysteine, and fibrinogen as cardiovascular risk factors.