Primordial prevention of atherosclerosis related cardiovascular disease

Primordial prevention of atherosclerosis related cardiovascular disease

Usually the three levels of prevention are primordial, primary and secondary. Primordial prevention is prevention of development of risk factors, mostly at a community level. Primary prevention is prevention of the disease by controlling risk factors before the development of the disease process. Secondary prevention is after the disease has occurred and is mostly prevention of recurrence and disability limitation. Most often individuals are very much motivated for secondary prevention while some are interested in primary prevention as well. Primordial prevention being mostly at the community level, individual role is limited, though every individual has to co-operate for community efforts to bear fruit.

Atherosclerosis, the main cause for cardiovascular disease starts very young and preventive efforts have to start early in life. Important risk factors which can be prevented are dyslipidemia, smoking, high blood pressure, high blood sugar and excessive weight. PDAY (Pathobiological Determinants of Atherosclerosis in Youth) research group studied data from about 3000 persons between 15-34 years who had died from accidents, homicides and suicides, obtained from forensic laboratories. Positive association was noted with VLDL plus LDL cholesterol levels, and negative association with HDL cholesterol and fatty streaks and raised lesions in aorta and right coronary artery, more so after the age of 25 years. Elevated glycosylated hemoglobin levels were associated with raised lesions through out the 15-34 age group. Body mass index was associated with fatty streaks and raised lesions in right coronary artery in males, but not in females. Smoking was associated with tripling of raised lesions in abdominal aorta in the 25-34 years age group. This study documented the need for long-range measures starting from early life for prevention of adult coronary artery disease.

STRIP (Special Turku Coronary Risk Factor Intervention Project) study was a longitudinal, randomized atherosclerosis prevention trial in which repeated dietary counseling aimed at reducing intake of saturated fat from infancy to early adulthood was provided. Participants who had full data on components of metabolic syndrome including waist circumference, blood pressure, triglycerides, glucose and HDL cholesterol were included in a substudy. In the intervention group, prevalence of metabolic syndrome varied from 6% to 7.5% between 15-20 years. Corresponding figures for the control group was 10% to 14%. Among the components of metabolic syndrome, the intervention decreased the risk of high blood pressure in both males and females. Occurrence of high triglycerides was reduced in male subjects. There was also a statistically nonsignificant reduction in the risk of high waist circumference in the intervention group [2].

It has been mentioned that the first 1000 days of life from conception to preschool ages are a period of maximal developmental plasticity. Preventive measures during this period may provide the best possible trajectories for lifelong cardiovascular health. Interventions at a later date may produce inadequate physiological responses. Efforts for primordial prevention of atherosclerosis and related cardiovascular diseases should probably start very early in life to have lasting impact. Later interventions may have little or no effect [3].

References

1. McGill HC Jr, McMahan CA. Determinants of atherosclerosis in the young. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Am J Cardiol. 1998 Nov 26;82(10B):30T-36T. doi: 10.1016/s0002-9149(98)00720-6. PMID: 9860371.
2. Nupponen M, Pahkala K, Juonala M, Magnussen CG, Niinikoski H, Rönnemaa T, Viikari JS, Saarinen M, Lagström H, Jula A, Simell O, Raitakari OT. Metabolic syndrome from adolescence to early adulthood: effect of infancy-onset dietary counseling of low saturated fat: the Special Turku Coronary Risk Factor Intervention Project (STRIP). Circulation. 2015 Feb 17;131(7):605-13. doi: 10.1161/CIRCULATIONAHA.114.010532. Epub 2015 Jan 20. PMID: 25605660.
3. Gillman MW. Primordial prevention of cardiovascular disease. Circulation. 2015 Feb 17;131(7):599-601. doi: 10.1161/CIRCULATIONAHA.115.014849. Epub 2015 Jan 20. PMID: 25605661; PMCID: PMC4349501.