An update on coronary risk factors

Epidemiologic research continues to produce additional independent risk factors, including small dense LDL, Lp(a), isolated systolic hypertension, the insulin-resistance syndrome, leucocyte count, plasma fibrinogen, homocystinemia, and sleep disturbance. Alcohol in moderation appears protective. Because the hazard posed by any particular risk factor is markedly influenced by other metabolically linked risk factors with which it tends to cluster, multivariate risk assessment provides a substantially better risk estimate than that based on single risk factors.