When should cardiovascular prevention begin? The importance of antenatal, perinatal and primordial prevention

Abstract

Cardiovascular diseases represent a major health problem, being one of the leading causes of morbidity and mortality worldwide. Therefore, in this scenario, cardiovascular prevention plays an essential role although it is difficult to establish when promoting and implementing preventive strategies. However, there is growing evidence that prevention should start even before birth, during pregnancy, aiming to avoid the onset of cardiovascular risk factors, since events that occur early in life have a great impact on the cardiovascular risk profile of an adult. The two pillars of this early preventive strategy are nutrition and physical exercise, together with prevention of cardio-metabolic diseases during pregnancy. This review attempts to gather the growing evidence of the benefits of antenatal, perinatal and primordial prevention, discussing also the possibility to reverse or to mitigate the cardiovascular profile developed in the initial stages of life. This could pave the way for future research, investigating the optimal time and duration of these preventing measures, their duration and maintenance in adulthood, and the most effective interventions according to the different age and guiding in the next years, the best clinical practice and the political strategies to cope with cardiovascular disease.

Antenatal, perinatal, and primordial cardiovascular prevention: What is known, what is happening, and future directions

“…4 This phenomenon does not only involve adults and the elderly, but, day by day, it is also playing a major role among adolescents and young adults. 3,5 It is important to stress that ASCVD factors are able to negatively impact each stage in life. Correctly, D'Ascenzi et al state that ASCVD prevention should start as soon as possible.…”

“…Correctly, D'Ascenzi et al state that ASCVD prevention should start as soon as possible. 3 The American Heart Association defined a new model of ''ideal cardiovascular health'' based on seven health metrics, for both children and adults, referred as ''Life's Simple 7'' 6 : four healthy behavioural items, such as non-smoking, having a normal body mass index, being physically active, and healthy eating; and three health factors, including blood pressure, cholesterol, and plasma glucose level.…”

“…7,8 The individual ASCVD risk profile is influenced by the genetic patrimony, which cannot be directly manipulated. 3 Nevertheless, D'Ascenzi et al correctly state that healthy behaviour in the family is very important also in this field, since a tight relation between genetics and environment exists, with a reciprocal influence. 3 Evidence is available [8][9][10] : dietary counselling, sodium restriction, and physical activity in children have beneficial effects on plasma lipid profile, blood pressure levels, and abdominal fat; also, insulin sensitivity and arterial stiffness are improved.…”

“…Nutrition and physical activity are also milestones in these stages of the life; in their review, D'Ascenzi et al underline some interesting data regarding their beneficial effects on endothelial function and retinal microcirculation. 3 Concerning the intrauterine life, pregnancy-related hypertensive disorders might significantly influence the ASCVD risk profile of the offspring 3 ; moreover, intrauterine exposure to a diabetic environment may have an impact on biventricular geometry and function later in the life. An appropriate method of management of these pregnancy-related disorders may play a relevant role as a preventive measure.…”

“…The paper by D'Ascenzi et al focuses on these very important topics, providing a complete review of the contributions available in the field. 3 In this commentary, starting with the paper by D'Ascenzi et al, 3 after a summary of the available knowledge in this area, an analysis of the gap between what we are doing and what we should do will be provided.…”