03/10/2008What is New in Preventing Heart Disease?

Majeed Paduvana, MD, FACP

Heart disease continues to be a major world wide problem.  Coronary artery disease (CAD), in particular, is a major killer  Specialists in Internal Medicine are really interested in preventive Cardiology.  Recently, evidence based data is pouring in regarding prevention of CAD.  Aggressive control of hypertension, diabetes along with regular exercise and avoidance of nicotine use will prevent heart disease to a great extent.

A number of clinical trials have unequivocally demonstrated the clinical utility of lowering LDA (“bad cholesterol”) levels.  The three major cholesterol lowering trials carried out in people without a history of coronary events include the West of Scotland Coronary Prevention Study (WOSCOPS), the Air Force/Texas Coronary Atherosclerosis Prevention Study and the Anglo-Scandinavian Cardiac Outcomes Trail.

A 10 year follow-up of WOSCOPS, that included more than 90% of the original trial survivors, showed a statistically significant reduction in death from coronary disease.  The remaining question is, what is the greatest therapeutic benefit that can be gained, particularly for primary prevention of the emergence of clinical coronray disease.  This question has two parts; (1) how early should treatment be started?  And (2) how low should the target LDL cholesterol level be set?

Recently published data from Cohen and Colleagues provide strong support for the notion that earlier treatment, even among asymptomatic individuals, may reduce the incidence of clinical coronary heart disease.  What, then, is the optimal target for LDL cholesterol?  Epidemiologic studies demonstrate a strong, graded association of serum LDL cholesterol and the coronary heart disease event rate.  In short, the lower the LDL level, the better for preventing heart disease.

Recent data also points to Vitamin D deficiency (lack of adequate Vitamin D intake) as a risk factor for cardiovascular disease.   

Links of Interest:

• More info on CAD from The National Heart, Lung, and Blood Institute (NHLBI)
• West of Scotland Coronary Prevention Study (WOSCOPS)
• New England Journal of Medicine - Primary Prevention of CAD
  

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