To the Editor.
—We agree with the assessment by Dr Hoeg1 that currently established CHD risk factors do not fully predict an individual's likelihood of developing symptomatic cardiovascular disease. His insights are relevant not only to primary prevention but also to applications dealing with the secondary prevention of CHD. This is particularly important to those of us addressing lifestyle factors in individuals with known cardiovascular disease. The inclusion by Hoeg of homocysteine in the expanded list of risk factors and the emergence of homocysteine as an independent risk factor for atherosclerotic vascular disease2 shed light on another important topic: the ability of lifestyle interventions to alter the course of cardiovascular disease.3 Although previous lifestyle interventions3 have been reported on a variety of conventional parameters including lipid levels, there continues to be great speculation as to all of the factors involved in the atherosclerotic regression previously documented. We now have
DeRose DJ, Mullen K, Muscat J. Expanding and Understanding Risk Factors for Coronary Heart Disease. JAMA. 1997;278(8):636. doi:10.1001/jama.1997.03550080046035