Preventing Heart Disease in the 21st Century

Abstract

W e could prevent 90% of heart attacks. Such a claim would have seemed outrageous in the 1960s, as the coronary heart disease (CHD) epidemic reached new heights and accounted for one third of all deaths in the United States and most other developed countries. 1 The identification of conditions that predicted the probability of CHD (known as "risk factors") stimulated hope that modification of these risk factors would reduce the frequency of CHD. Long before this idea was validated in clinical trials, individual physicians 2,3 and voluntary health agencies 4 began in the 1960s to promote the concept to the public. Many individuals accepted the idea, and many physicians adopted the recommendations in their practices.The US CHD mortality rate declined to approximately half its former level by 1990. 5 The associated favorable changes in risk factors accounted for about half of this decline, whereas improved treatment of CHD accounted for the other half. 6 The extent and severity of atherosclerosis also declined during this period. 7,8 CHD mortality continued to decline after 1990 but at a slower rate, and CHD remained the leading cause of death in the United States. 9 A convergence of evidence from diverse sources in the last 2 decades now indicates that the claim that we can prevent 90% of CHD should no longer be thought of as outrageous but as achievable. For example, the absence of the major established CHD risk factors at 50 years of age has been shown to indicate a 90% lower lifetime risk (to age 95 years) for men and a 79% lower risk for women. 10 * Subjects in several large cohorts without any of the major risk factors who were followed up for 16 to 22 years had 77% to 92% lower (men) or 79% lower (women) CHD mortality. 11 † A mutation in PCSK9, a gene that regulates low-density lipoprotein (LDL) cholesterol, has been shown to result in a 28% reduction in LDL cholesterol and an 88% lower risk of CHD. 12 The present report reviews the benefits and limitations of CHD prevention efforts in adults and attempts to expand prevention efforts to young people. We summarize evidence showing that CHD risk factors are associated with both the early and advanced stages of atherosclerosis. This evidence supports the need to maintain a low lifetime risk by preventing development of risk factors in youth or controlling risk factors if they do develop, measures that will prevent atherosclerosis and thereby prevent CHD. Risk Factor Control in Adults Reduces but Does Not Eliminate CHDA number of controlled clinical trials of fat-modified diets 13 and drugs 14 yielded mixed results, but ultimately, modification of individual risk factors in adults was shown to reduce CHD risk. Cholestyramine was proven to lower LDL cholesterol levels and reduce CHD incidence 15 ; a decade later, a statin was shown to lower LDL cholesterol and CHD incidence more effectively. 16 Smoking cessation has also been shown to reduce the incidence of CHD. 17 Pharmacological treatment of hypertension lowers both the incidence of CHD and the incidence of is...

Assessment of Knowledge and Awareness on Cardiovascular Risk Factors in a Teaching Hospital

“…Comparing our study observations, out of 105 patients 52.4% were uneducated, 12.4% with primary education, 28.6% with secondary education, 2.9% with pre-university and 3.8% with degree education. In addition, in another study, 71.8% were having an occupation 8 and a fewer women have household incomes. 3 The results of our study reveals that, 6.6% were unemployed and 13.3% were employed and about 93.3% of patients are aware about high blood pressure and diabetes as a risk factor which is followed by smoking 85.7% and overweight 60% which can be compared with a study showing that 92% had a good knowledge on fatty food consumption, 83% were aware of smoking, 42% were aware about obesity as a risk factor and only 25% knows about the protective effect of exercise.…”

Desconhecimento da diretriz de prevenção da aterosclerose na infância e adolescência por pediatras em São Paulo

“…Mudanças na saúde pública associadas às transformações sociais e culturais também são necessárias para atingir a população como um todo. A participação dos pais e médicos em interação com os demais profissionais da saúde, educadores, cientistas e legisladores é fundamental para garantir a aplicabilidade das recomendações fornecidas pela diretriz 22,23 .…”

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

“…Additional research has indicated that pathological changes, such as markers of atherosclerosis and changes in left ventricular morphology, measured concurrently or in Kelly RK et al . Youth blood pressure and adulthood outcomes adulthood, are associated with elevated youth blood pressure [10][11][12][13][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] . These changes are largely asymptomatic and are detectable prior to signs of end-organ damage such as nephropathy and retinopathy.…”