Atherosclerotic disease is the leading cause of mortality and morbidity in Europe and in most of the world (Eur Heart J 2004; 25: 1197-1207). In Western Europe the incidence of cardiovascular disease is declining, thanks to intense action on risk factors for these diseases, while in other European countries this decline has not yet been found. The Framingham Study has been the first study which has demonstrated that the classical risk factors such as smoking, hyperlipidemia, hypertension and diabetes are the major determinants of cardiocerebrovascular disease (Circulation 1991; 83: 356-362). The INTERHEART Study also has underlined the importance of lifestyle, exercise, intake of fruits and vegetables, psychological factors, and of course all classic risk factors for the prevention of myocardial infarction and to prevent generally cardiocerebrovascular disease (Lancet 2004, 364: 937-952). Turkey has a population of 70.5 million and a low average age, 29 years according to statistics published in 2007 (www.tuik.gov.tr). Despite low average age, the prevalence of atherosclerotic disease is unexpectedly high. The rate of coronary mortality is about 5 to 100 people and is the highest in Europe (Atherosclerosis 2001, 156: 1-10). Unfortunately the other risk factors are not stable and it is estimated that the incidence of coronary heart disease will grow by 7% annually for the next 10 years.
Let us now briefly the studies done in Turkey to define the various risk factors.

• TEKHARF (The Turkish Adult Risk Factor Survey): 3687 subjects aged 20 years, selected from seven geographic regions, were stratified by age, gender or rural and urban distribution (Arch Turk Soc Cardiol 2001; 29: 8-19 ).
• THS (The Turkish Heart Study): has focused attention on plasma lipids, apolipoproteins. Were enrolled approximately 9,000 men and women from six different regions with different diets (J Lipid Res 1995, 36: 839-859).
• TURDEP (The Turkish Diabetes Epidemiology Study): study populations to determine the prevalence of diabetes and glucose intolerance in Turkey, both in rural areas than in urban areas. The study enrolled 24,788 subjects aged 20 years (Diabetes Care 2002; 25: 1551-1556).
• Then there are also other studies such as Paten T (Prevalence, awareness, treatment and control of hypertension in Turkey - J Hypertens 2005, 23: 1817-1823), TURKSAHA (treatment and control of hypertension in the Turkish population - J Hum Hypertens 2006, 20: 355-361) and METS (prevalence of metabolic syndrome among Turkish adults) who have reported more data on risk factors in this population.

TEKHARF has showed that the average concentration of total cholesterol was 185 mg/dL in men and 192 mg/dL in women and this concentration was higher than that recorded in Western Europe and the USA. THS has showed that in 32% of men and 22% of women there were total cholesterol levels above 200 mg/dL. These studies have confirmed that hypercholesterolemia is not a risk factor prevalent in Turkey as it is in western Europe. Hypertriglyceridemia, defined as levels above 150 mg/dL was present in 39% of men and 29% of women, according to the study TEKHARF. The THS has demonstrated that HDL levels were significantly lower in Turkey, the average was 38.3 mg/dL in men and 45.5 mg/dL in women. The prevalence (38.8%) of hypertension was highlighted by the study Paten T, and was higher in women (36.1% vs 27.5%). According to data of TEKHARF systolic pressure is the main predictive risk factor for mortality and morbidity from coronary disease in both genders at 5 years (Int J Cardiol 1997; 61: 69-77). Cigarette smoking is a major public health problems in Turkey. While in recent decades in western countries the trend is negative in Turkey has increased by 20% (Anadolu Kardiyol Derg 2006; 6: 60-67). TURDEP has showed that the prevalence of diabetes was found to be 7.2% and glucose intolerance of 6.7%. Prevalence of diabetes is lower in men (6.2% vs 8%).
Although diabetes mellitus was found to be a significant predictor for coronary heart disease. Metabolic syndrome affects 14% of men and 30% of women and obesity is a major problem in Turkey. The authors conclude the article by recalling the priorities: 1) smoking, 2) hypertension, 3) obesity and the need for intervention programs at the national level for prevention.