Itâ€™s 2012 already. Time flies; doesnâ€™t it?
It seems like just yesterday when…
I started this business more than two decades ago. A time when cell phones hadnâ€™t even graced James Bond movies; we got up to change the channel on TV and the world health concern of the moment was a Hunger Games-like scenario induced by a US-USSR confrontation. That was a long time ago indeed.
Letâ€™s think back to medical school lessons circa 1985. One of the first tenets we learned was that hardening of the arteries led to heart disease, and this slow steady process begins in childhood.
Though Medicine has come a long way in the past two decades, Iâ€™m left wondering what it means that major journals continue to publish–and major heart meetings still feature–trials that retell the long-known and obvious story of how heart disease takes hold.
Specifically, I ask myself how it is news that making basic healthy lifestyle choices in childhood pays huge dividends later in life? Is it really that stunning to read in this Circulation study from Finland that kids with the highest scores in the AHAâ€™s big seven features of health had better blood pressure, less obesity and more pristine carotid arteries as adults?
Hereâ€™s another of the featured presentations at this weekâ€™s ACC. As outlined in this theHeart.org piece, researchers from Detroit boldly conclude:
â€œLowering LDL [bad cholesterol] early in life has the potential to reduce coronary heart disease to a far greater extent than starting treatment later in lifeâ€”the current standard practice.â€
Imagineâ€¦those with lower levels of bad cholesterol since childhood did better as adults. (Of course, the most interesting question here is whether achieving low cholesterol levels with drugs equals just having it because of exercise, diet and good genes. My hunch: donâ€™t bet that the means achieve the same ends.)
This throwback stuff reminds me of my old collection of ties. Whatâ€™s old always seems to come back around again. Gosh folks, the idea that eating too much (even chocolate) and moving too little causes heart disease is ancient. I just canâ€™t remember basic common sense studies like these two garnering this much attention in years past. Maybe it wasnâ€™t an issue when kids still had daily gym class, personal computers barely existed and heart docs were too busy studying Swan-Ganz catheters as treatment for heart attacks.
But times have changed. Smart people, no check that, really smart people are starting to use really complicated terms for the basic program. Masters of the obvious call daily exercise, smart food choices, good sleep hygiene and an upbeat optimistic attitude, â€˜the programâ€™, or â€˜the planâ€™. Academic types now have named ze plan: â€˜primordialâ€™ prevention.
Until recently, most of us thought about only two kinds of prevention of heart disease, primary and secondary. Secondary prevention means treating all the risk factors of heart disease after a patient has suffered an event. Things like prescribing statins, beta-blockers, ACE-inhibitors and aspirin; treating high blood pressure and maximizing LDL levels are all strategies known to reduce the chance of a second heart event. Similarly, primary prevention implies treating the same conditions in an effort to prevent the first cardiac event.
Primordial prevention comes before all this. Overqualified heart doctors call such strategies, â€˜upstreamâ€™ treatment. In real words: to primordially prevent heart disease entails taking basic actions (move, eat less, sleep and smile) to prevent the causes (of the causes) of hardening of the arteries. Primeval maneuvers, or â€˜small choices made every day,â€™ beginning in childhood, slow the onset of diabetes, high blood pressure and elevated cholesterolâ€”the main diseases that cause heart disease.
Just like we learned way back when. Like Mr Berra said:
â€Itâ€™s dÃ©jÃ vu all over again.”
In conclusion, I’ll leave with this final thought: Perhaps we need more scientific inquiry into effective and novel means to incent folks to embrace primordial prevention. Solutions here will be tough, as they will require cooperation on many fronts. Wisdom from doctors forms only a small part of the solution. Positive changes will have to happen at the community and economic level. (I know; the bike path argument sounds progressive.) To replicate healthy communities like San Luis Obispo, Boulder and Hamburg Germany on a grand scale won’t be easy. For if it was, heart docs would have more time to blog.