Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention

Abstract

Americans are under assault by a fierce epidemic of obesity, diabetes, and cardiovascular disease, of their own doing. Lowered death rates from heart disease and reduced rates of smoking are seriously threatened by the inexorable rise in overweight and obesity. Latest data indicate that 32% of children are overweight or obese, and fewer than 17% exercise sufficiently. Over 68% of adults are overweight, 35% are obese, nearly 40% fulfill criteria for the metabolic syndrome, 8-13% have diabetes, 34% have hypertension, 36% have prehypertension, 29% have prediabetes, 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed, 59% engage in no vigorous activity, and fewer than 5% of the US population qualifies for the American Heart Association (AHA) definition of ideal cardiovascular health. Health, nutrition, and exercise illiteracy is prevalent, while misinformation and unrealistic expectations are the norm. Half of American adults have at least one cardiovascular risk factor. Up to 65% do not have their conventional risk biomarkers under control. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are treated according to evidence-based protocols, about 70% of cardiac events remain unaddressed. Undertreatment is also common. Poor patient adherence, probably well below 50%, adds further difficulty in reducing cardiovascular risk. Available data indicate that only a modest fraction of the total cardiovascular risk burden in the population is actually now being eliminated. A fresh view of these issues, a change in current philosophy, leading to new and different, multimechanistic methods of prevention may be needed. Adherence to published guidelines will improve substantially outcomes in both primary and secondary prevention. Primordial prevention, which does not allow risk values to appear in a population, affords more complete protection than subsequent partial reversal of elevated risk factors or biomarkers. Current evidence supports recent calls for massive educational programs supporting primordial prevention, individual responsibility and pride in achieving population-wide ideal cardiovascular health through lifestyle modification. Environmental and social changes will be necessary, along with major supportive adjustments in the food industry and the assistance of the media. Cooperation is critical to the success of such an initiative.

Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

“…The failure to control high BP is multi-factorial in most patients, but usually includes lack of disease awareness, lack of consensus among treatment guidelines, diet and lifestyle factors, poor patient adherence to dietary/lifestyle initiatives and prescribed drug regimens (Sever et al, 2009). Irrespective of the level of HTN, lowering of BP is always preferable by non-pharmacological means such as adequate sleep, low salt diet, weight loss, exercise and alcohol restriction (Williams, 2008;Kones, 2011).…”

Cardiovascular Risk Management Must Always Consider Social Determinants of Health: Past Lessons, Data, Proposals and Challenges

“…There is a linear relationship between number and intensity of risk factors and subsequent cardiovascular (CV) outcomes [14,15]. Tracking of common risk factors from youth to adulthood, which receives greatest attention in health systems focused upon individual risk, is a well-documented phenomenon [16][17][18].…”

Latina mothers feeding their children: A focus group pilot study

“…Particularly concerning is the increase of children presenting with illnesses thought to occur predominantly in the adult population, such as high blood pressure, dyslipidemia, atherosclerosis, and Type 2 diabetes [5,6]. Although studies have attempted to understand effective interventions that promote healthier eating habits, the adoption of dietary and fitness lifestyle changes known to reduce obesity and chronic disease risks has not occurred in any meaningful proportion [7]. Presented here are preliminary data on the question of whether parents perceive the problem of childhood obesity, and what struggles parents face in helping their children to be healthy.…”

“…While obesity rates in the US continue to rise, the adoption of dietary and fitness lifestyle changes known reduce OPEN ACCESS chronic disease risks has not occurred in any meaningful proportion [7]. Many parents are aware of the issue of obesity, but often struggle to feed their children what they view as a healthy diet, and/or facilitate physical activity.…”

“…Many parents are aware of the issue of obesity, but often struggle to feed their children what they view as a healthy diet, and/or facilitate physical activity. In fact, parents reveal a strong interest in improving the diets they feed their children and themselves, in understanding what constitutes a healthy weight for children, and a concern for the physical and psychological ramifications of carrying excess weight [7][8][9]. Many studies show that Latino parents actually possess a fair amount of knowledge about good nutrition and exercise, and possess a strong perception of self-efficacy in their ability to control their child's weight [5,10,11].…”