Prospects for the Primary Prevention of Myocardial Infarction and Stroke

Abstract

Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem in the United States and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity, both of which are alarmingly common in the United States, prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke as well as other clinical manifestations of CVD. Although adoption of TLCs would avoid the need for adjunctive drug therapies in many primary prevention subjects, this strategy is difficult to achieve or maintain for most and may be insufficient for many, especially those at high risk with metabolic syndrome. The criteria for metabolic syndrome, affecting over 40% of the adult population older than 40 in the United States, include overweight or obesity, dyslipidemia, hypertension, and insulin resistance, a precursor of diabetes. The adjunctive therapies of proven benefit in the primary prevention of MI and stroke include statins, blood pressure medications, aspirin, and drugs to treat insulin resistance and hyperglycemia. Fortunately, even for patients who prefer prescription of pills to proscription of harmful lifestyles, these drug therapies still have net benefits. The adoption and maintenance of TLCs and adjunctive drug therapies into clinical practice will reduce both the incidence of and mortality from a first MI and stroke as well as other major clinical manifestations of CVD.

Fibroblast growth factor 21: an endocrine inhibitor of sugar and alcohol appetite

“…Moreover, independent of their effects on body weight, certain nutrients (i.e. simple sugars, saturated fats and alcohol) can have deleterious effects on metabolic and cardiovascular risk factors -the well-established hypertensive effect of excess alcohol intake, for example -providing further clinical rationale for delineating the biological basis of food, and beverage, selection (Caldwell et al 2019).…”

Reading and Interpreting the Literature on Randomized Controlled Trials

“…Human health has improved over the centuries and even over recent decades. Some of that improvement has been due to better treatments of disease and some to better strategies for prevention (Caldwell et al 2019). The data from randomized controlled trials have led to a portion of those improvements.…”

Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research

“…Hypertension (HTN) is a major public health concern and remains a leading risk factor for stroke and cardiovascular disease 1 – 4 . The diagnosis and treatment of HTN is straightforward, but the lack of control is commonplace with about 40% of treated patients achieving blood pressure targets in the United States 5 .…”