Coronary artery disease: Primary care and prevention – 4

Prevention of CAD

Prevention of CAD: Prevention is classified into primordial, primary and secondary. Primordial prevention is community level intervention to reduce risk factors and mostly not under the purview of the individual physician. Primary prevention is by controlling the risk factors.

Non modifiable risk factors for CAD

Age, gender, race/ethnicity and genetic predisposition or family history are considered the non modifiable risk factors for CAD. Prevalence of CAD increases as age advances and it is definitely more common in males. A strongly positive family history of premature coronary artery disease increases the risk of CAD.

Important modifiable risk factors for CAD

Hypertension, dyslipidemia, diabetes mellitus, cigarette smoking, obesity and chronic kidney disease are important modifiable risk factors for CAD. Diabetes mellitus is such a strong risk factor that it is even considered as a CAD equivalent by some. In this era of regular dialysis programs, chronic kidney disease seldom die of progressive renal failure, but of CAD.

Smoking and CAD

Smoking increases the risk of CAD and reduces the life expectancy by 13.2 years in males and 14.5 years in females [1]. Even second hand smoke as received by spouse and children, increases the risk of CAD by 25-30% [2]. Smoking cessation achieves 15% reduction in mortality over 14 years.

Suggested additional reading: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.

Heart healthy diet

A diet based on vegetables, fruits, whole grains, low fat dairy products, poultry, fish, legumes and nuts is recommended. Sodium intake should be restricted to less than 2400 mg in hypertensive individuals. One needs to limit the intake of sweets, sugar sweetened beverages, red meats, saturated fat and trans fat. It may be noted that liquid calories do not improve satiety, but at the same time contributes well to the total calorie load.

Physical activity

Aerobic physical activity of moderate – vigorous intensity, lasting average 40 minutes per session, with 3-4 sessions a week is recommended. It is useful in reducing blood pressure and LDL cholesterol levels.

Reference

1. Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs–United States, 1995-1999. MMWR Morb Mortal Wkly Rep. 2002 Apr 12;51(14):300-3. PMID: 12002168.
2. Health Effects of Secondhand Smoke. Centers for Disease Control and Prevention Website. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm Accessed on 5th March 2021.

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