We start with overall cardiovascular risk assessment since it is one of the most important areas in personal health and the exploration of cardiovascular risk factors has such a long and storied history.

Cardiovascular risk refers to the risk of developing a subset of the cardiac disease known as cardiovascular disease. Cardiovascular disease (CVD) refers to dysfunction of the circulatory system caused by a narrowing and/or clogging of the arteries that supply blood to tissues, a process known as atherosclerosis. It encompasses a broad set of cardiac diseases, which include the following:

• Coronary artery disease (CAD): This occurs when the blood vessels that supply blood to the heart become narrowed due to atherosclerosis. CAD is deadly because it can lead to sudden occlusion of the coronary arteries, which is known as a myocardial infarction (or a heart attack).
• Congestive heart failure (CHF): This is the failure of the heart to pump blood to the rest of the body. It is caused by the long-term effects of CAD on the heart. It has an onset that is more gradual than myocardial infarction, however, its course is often characterized by sudden exacerbations and hospitalizations before ultimately leading to death.
• Peripheral vascular disease (PVD): This is when arteries that supply blood to the arms or legs become narrowed and occluded, which can lead to problematic symptoms such as pain (known as claudication) and may result in amputations.
• Cerebrovascular disease, or atherosclerosis of the vessels supplying the brain: This puts individuals at higher risk for ischemic and hemorrhagic stroke. Stroke is when the blood supply to the brain is cut off, which can lead to death and also can lead to devastating sequelae.

Now that you know what CVD is, you should also know its devastating effects on humans. Globally, it is the leading cause of morbidity and mortality (Weng et al., 2017). CHF alone is related to 3-5% of hospital admissions and is the leading cause of hospital admissions for healthcare professionals and accounts for up to 2% of total healthcare expenditures in developed countries (Tripoliti et al., 2016).

Although CVD had been a prominent cause of disability and death in the United States since the beginning of the twentieth century, in the 1940s, people still had no idea what caused it. In fact, during that time, little was understood about the risk and prevention of CVDs (and disease in general). At the time, it was believed that CVD was the destiny of whomever it affected, independent of lifestyle decisions.