Volume : 11, Issue : 01, January – 2024

Title:

PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE: A REVIEW OF CONTEMPORARY GUIDANCE AND LITERATURE

Authors :

JS Venkatesh, Vinuth Chikkamath, Stefi A Mathew, Sofy sunny, Sherin Anna Shaji

Abstract :

Cardiovascular disease is a serious and rapidly expanding issue in the worldwide , contributing to about one-third of all fatalities and causing a substantial amount of morbidity. Additionally, it is of urgent concern as developing nations undergo lifestyle changes that bring new cardiovascular disease risk factors, sparking an increase in risk of cardiovascular disease in underdeveloped nations. Since careful risk reduction can lessen the burden of cardiovascular disease, primary prevention should be a top focus for all those who establish health policy. International guidelines are highly consistent about the need to stop smoking, optimise weight, and emphasise the value of exercise. However, guidelines differ slightly about how to treat hypertension and significantly about how to achieve an optimal lipid profile, which is still a concern. While once-popular concepts like the polypill seem to have no in-vivo value, there are still areas of potential future research, such as the advantages of lowering homocysteine and serum urates.
Keywords: Primary prevention, cardiovascular disease, statins, exercise, diet, hypertension, smoking, alcohol, polypill, uric acid

Cite This Article:

Please cite this article in press Sofy Sunny et al., Primary prevention of cardiovascular disease: A review of contemporary guidance and literature, Indo Am. J. P. Sci, 2024; 11 (01).

Number of Downloads : 10

References:

1. WHO. Cardiovascular diseases (CVDs). 2016. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/ (accessed 10 October 2016).
2. Nichols M, Townsend N, Luengo-Fernandez R, et al. European Cardiovascular Disease Statistics. European Cardiovascular Disease Statistics 2012 edition, Brussels, Belgium: European Heart Network AISBL, 2012.
3. Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012; 33: 1635–1701
4. WHO. The challenge of cardiovascular disease – quick statistics, 2016. Available at: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics (accessed 10 October 2016).
5. Kannel WB, Doyle JT, Shephard RJ, et al. Prevention of cardiovascular disease in the elderly. J Am Coll Cardiol 1987; 10: 25A–28A.
6. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. The Lancet 2004; 364: 937–952.
7. NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE Guideline CG181, 2016.
8. NICE. NICE Guideline CG127. NICE Guidelines, 2011.
9. NICE. Cardiovascular disease prevention. NICE Guideline PH25, 2010.
10. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381.
11. Council ES, Redon J, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J 2013; 34: 2159–2219.
12. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013. 2014: 63(25_PA).
13. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: 2889–2934.
14. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation 1997; 96: 3243–3247.
15. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–520
16. Marijon E, Tafflet M, Celermajer DS, et al. Sports-related sudden death in the general population. Circulation 2011; 124: 672–681.
17. Sattelmair J, Pertman J, Ding EL, et al. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011; 124: 789–795.
18. MODIFICATION L. Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease, London: NICE, 2008, 2008.
19. de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015; 351: h3978–h3978.
20. Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation 2004; 109: 1101–1107.
21. Law MR, Wald NJ. Environmental tobacco smoke and ischemic heart disease. Prog Cardiovasc Dis 2003; 46: 31–38
22. Fiore MC, Smith SS, Jorenby DE, et al. The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA 1994; 271: 1940–1947.
23. Kottke TE, Battista RN, DeFriese GH, et al. Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials. JAMA 1988; 259: 2882–2889.
24. Tzivoni D, Keren A, Meyler S, et al. Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking. Cardiovasc Drugs Ther 1998; 12: 239–244.
25. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Health Education Authority. Thorax 2000; 55: 987–999.
26. Bhatnagar A. E-Cigarettes and cardiovascular disease risk: evaluation of evidence, policy implications, and recommendations. Curr Cardiovasc Risk Rep 2016; 10: 1–10.
27. Khosravi A, Akhavan Tabib A, Golshadi I, et al. The relationship between weight and CVD risk factors in a sample population from central Iran (based on IHHP). ARYA Atheroscler 2012; 8: 82–89.
28. Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation 2012; 126: 1301–1313.
29. Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol 1990; 66: 1237–1242.
30. Leong DP, Smyth A, Teo KK, et al. Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation 2014; 130: 390–398.
31. Holmes MV, Dale CE, Zuccolo L, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 2014; 349: g4164–g4164.
32. Garcia S. Alcohol Consumption and CVD: The case for moderation, 2015. Available at: http://www.acc.org/latest-in-cardiology/articles/2015/01/05/13/06/alcohol-consumption-and-cvd-the-case-for-moderation (accessed 25 October 2016).
33. Liberty Pharmaceuticals. Atorvastatin, 2016. Available at: https://www.drugs.com/pro/atorvastatin.html (accessed 10 October 2016).
34. Abramson JD, Rosenberg HG, Jewell N, et al. Should people at low risk of cardiovascular disease take a statin? BMJ 2013; 347 f6123.
35. ClinRisk. QRISK®2-2016 cardiovascular disease risk calculator, 2016. Available at: https://qrisk.org/2016/ (accessed 10 October 2016).
36. Interpretation of the evidence for the efficacy and safety of statin therapy Collins, Rory et al. The Lancet 2016; 388: 2532–2561.
37. Robinson JG, Farnier M, Krempf M, et al. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med 2015; 372: 1489–1499.
38. NICE. Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia. NICE Guideline TA393 2016 05/05.
39. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet 2002; 360: 1903–1913.
40. MacMahon S, Peto R, Collins R, et al. Blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. The Lancet 1990; 335: 765–774.
41. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665–b1665.
42. Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 2016; 352: i717–i717.
43. Chobanian A. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.
44. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. The Lancet 1998; 351: 1755–1762.
45. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665–b1665.
46. Cushman W, Ford C, Cutler J, et al. ALLHAT Collaborative Research Group: success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002; 4: 393–404.
47. Khan JM, Beevers DG. Management of hypertension in ethnic minorities. Heart 2005; 91: 1105–1109.
48. ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.
49. Dickinson HO, Mason JM, Nicolson DJ, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24: 215–233.
50. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 2007; 334: 885–888.
51. Obarzanek E, Proschan MA, Vollmer WM, et al. Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial. Hypertension 2003; 42: 459–467.
52. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The Lancet 2010; 375: 2215–2222.
53. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–412.
54. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559.
55. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117–2128.
56. Halvorsen S, Andreotti F, Jurriën M, et al. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol 2014; 64: 319–327.
57. Hughes A. One pill, four questions: what we still need to know about reducing cardiovascular risk with combination therapy. Cochrane Database Syst Rev 2014; (4): ED000079.
58. Chen J, Lan J, Cheng C, et al. Effect of urate-lowering therapy on all-cause and cardiovascular mortality in hyperuricemia patients without Gout: a case-matched cohort study. PloS One 2015; 10: e0145193–e0145193.
59. Chen JH, Lan JL, Cheng CF, et al. Effect of urate-lowering therapy on the risk of cardiovascular disease and all-cause mortality in patients with gout: a case-matched cohort study. J Rheumatol 2015; 42: 1694–1701.
60. Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J 2015; 14: 1.