HISTORICAL DEVELOPMENT OF THE CONCEPT OF CARDIOVASCULAR AND RENAL RISK FACTOR

Abstract

At the beginning of the 20th century, infectious diseases were the leading cause of death, but with advances in medicine and greater access to healthcare, mortality from these diseases decreased; by 1940, cardiovascular diseases (CVD) were the leading causes of death. In 1947, the Framingham Study began, focusing on the main causes of CVD (atherosclerotic and high blood pressure (HBP). In the 1950s, the causes of coronary heart disease were hypertension, high cholesterol, smoking, and diabetes (DBT). In 1961, the concept of "risk factor" (RF) was coined, recognizing that a combination of factors increased risk. In 1998, the Framingham Score became a key tool in the prevention, diagnosis, and treatment of CVD. In 2000, CVD was recognized as the leading cause of death in patients with CKD, and similar strategies should be used to prevent both CVD and CKD, given the common RFs (diabetes, hypertension, low HDL cholesterol). Albuminuria was identified as a marker and predictor of CKD and CVD progression. Non-traditional RFs for CVD in CKD were later recognized: chronic inflammation, oxidative stress, and altered phosphocalcic metabolism. Subsequently, low birth weight (LBW) was associated with an increased risk of chronic non-communicable diseases, including CVD and CKD (Barker hypothesis); renal studies confirmed a reduction in the number of nephrons in newborns with LBW.