According to the WHO, 17 million people die every year from cardiovascular disease. This currently makes cardiovascular disease the leading killer in industrialised countries where it accounts for 40 % of deaths, far outstripping cancer (FIGURE I). It is also the primary cause of premature death, the leading cause of permanent disability and the main reason for hospital admittance.

But, a particularly alarming observation in countries where cardiovascular mortality is highly prevalent, e.g. the United States and Northern European countries, is that whereas this mortality had decreased substantially in the 1960s to 1990s (-60 % in the United States), it now appears to have reached a plateau. And, contrary to popular belief, cardiovascular mortality is higher in women than in men, and is increasing in women (FIGURE II).

The disease is progressing even more substantially in the countries of the former Soviet Union and in most developing countries where it increases in parallel with industrialisation, urbanisation and changes in lifestyle. The progress noted over the last 2 decades in developed countries has resulted from the consideration of major risk factors such as smoking, alcohol, hypertension, cholesterol and diabetes, and the use of increasingly well-defined therapeutic strategies based on new and effective drugs.

However, it is feared that cardiovascular mortality will soon be on the increase, as already observed in women in the United States. We must therefore look beyond managing the obvious risk factors: How can we identify the root of the problem ? How can we screen earlier for those who, though asymptomatic, run a high risk of suffering a cardiovascular accident ?