Cycling Wed Healthy Living

CW: When old (primordial) news makes big news.

It’s 2012 already. Time flies; doesn’t it?

It seems like just yesterday when…

I started this business more than two decades ago. A time when cell phones hadn’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.

Let’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, I’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 AHA’s big seven features of health had better blood pressure, less obesity and more pristine carotid arteries as adults?

Here’s another of the featured presentations at this week’s ACC. As outlined in this piece, researchers from Detroit boldly conclude:

“Lowering LDL [bad cholesterol] early in life has the potential to reduce coronary heart disease to a far greater extent than starting treatment later in life—the current standard practice.”

Imagine…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: don’t bet that the means achieve the same ends.)

This throwback stuff reminds me of my old collection of ties. What’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 can’t remember basic common sense studies like these two garnering this much attention in years past. Maybe it wasn’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, ‘the program’, or ‘the plan’. Academic types now have named ze plan: ‘primordial’ 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, ‘upstream’ 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 ‘small choices made every day,’ beginning in childhood, slow the onset of diabetes, high blood pressure and elevated cholesterol—the main diseases that cause heart disease.

Just like we learned way back when. Like Mr Berra said:

”It’s déjà 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.


5 replies on “CW: When old (primordial) news makes big news.”

Hello Dr. John
I thought the same thing while I watched an obese mother pouring Coca-Cola into her (obese) toddler’s baby bottle at the Minneapolis airport: lifestyle habits start very very early, both good and bad ones.

Other news flashes from the ACC12 event that seemed like trips down memory lane: turns out that cardiac rehab is very good for heart patients’ outcomes, yet very few cardiologists are referring their patients. Still! Or this, from the Canadian Cardiovascular Congress in Vancouver last fall: women fare worse than men after cardiac events. Still!

I’m waiting for the study that confirms Coca-Cola for infants is not a sound nutritional practice.

Thanks CT. Another oldie from ACC was the observational study showing long-term outcomes were better with bypass than stenting. This concept, that bypass, especially LIMA-LAD, betters percutaneous techniques or medical therapy dates back many years as well. Cheers.

Growing up, our two sons played competitive hockey on travel teams. Any parent who has been through that knows how hectic it can be to shuttle your kids to several practices and games (some out of town) each week. The sports kept the kids fit, but the lifestyle led to a lot of meals on the run where the food choices were, well, less than ideal. One of our kids could eat anything and not gain an ounce, the other had the opposite problem. It’s hard to beat genetics.

For starters, PE should not be an ELECTIVE in school, and Pizza and French Fries should not constitute a “varied and balanced diet” for school lunches.

I just received a newsletter from a local cardiology group. It had this quote from Hippocrates.

“If we could give every individual the
right amount of nourishment and exercise,
not too little and not too much,
we would have found the safest way to health.”

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