Journal of Medical Nutrition and Nutraceuticals

EDITORIAL
Year
: 2015  |  Volume : 4  |  Issue : 2  |  Page : 61--62

Primordial prevention of atherosclerotic vascular disease: Preventing the “pre-event”


Manash P Baruah1, Sanjay Kalra1, Bharti Kalra2,  
1 Consultant Endocrinology, Excel Center (Initiative of Excel Care Hospital), Guwahati, Assam, India
2 Department of Obstretrician and Gynecologist, Bharti Hospital, Karnal, Haryana, India

Correspondence Address:
Manash P Baruah
Excel Center (Initiative of Excel Care Hospital), Barthakur Mill Road, Ulubari, Guwahati - 781 007, Assam
India




How to cite this article:
Baruah MP, Kalra S, Kalra B. Primordial prevention of atherosclerotic vascular disease: Preventing the “pre-event”.J Med Nutr Nutraceut 2015;4:61-62


How to cite this URL:
Baruah MP, Kalra S, Kalra B. Primordial prevention of atherosclerotic vascular disease: Preventing the “pre-event”. J Med Nutr Nutraceut [serial online] 2015 [cited 2018 Dec 12 ];4:61-62
Available from: http://www.jmnn.org/text.asp?2015/4/2/61/162169


Full Text



Atherosclerotic vascular disease (ASVD) is an important public health and clinical challenge and has evolved as a major contributor to morbidity, disability, and death. While multiple advances in therapeutics have helped improve survival rates in ASVD, the need for prevention, rather than treatment, of patients with this condition, cannot be over emphasized.

 The Conventional Doctrine in Prevention



Much has been discussed about the different levels of prevention of ASVD over the past 50 years or so! Conventionally, primary prevention implies treating the well-recognized risk factors to avoid the first macrovascular event, secondary prevention looks at evasion of recurrent cardiovascular (CV) events, and tertiary prevention focuses on disability limitation and rehabilitation. Various evidence-based guidelines address the approach to each of these levels of prevention.

 Primordial Prevention



Ushering in a paradigm shift from focusing solely on the curtailment of the risks factors, another level of preventive strategy intends to prevent such risk factors from arising at all! Primordial prevention has been defined as actions to minimize future hazards to health and hence inhibit the establishment factors (environmental, economic, social, behavioral, cultural) known to increase the risk of disease.[1] How does it then differ from primary prevention? While primary prevention is aimed at preventing the exposure of an individual to risk factors, primordial prevention, on the other hand, addresses broad health determinants.[2] For example, banning smoking at all public places can be considered as primordial, while counseling smokers against the hazards of ASVD or cancer may be considered as primary prevention.

For a clinician or caregiver who has been taught risk-based approach all along, primordial prevention may seem a theoretical concept. However, it is pertinent to discuss and debate the logic behind such a strategy, and, of course, its applicability in one’s own domain of clinical practice. In this editorial, we take up the case of pediatric dyslipidemia and discuss how the primordial prevention approach is evolving in this particular field.

 Pragmatic Approach



Population-wide interventions can be hugely successful in changing the face of a dreaded disease. For example, universal salt iodization has brought down cretinism to an almost nonexistent level. However, we are all aware of the fact that this intervention involved mobilizing public sentiments, a strong political will, legislation, and community participation at multiple levels.[3] A similar approach can be suggested for the primordial prevention of ASVD [Table 1]. This will include extensive lifestyle modification, including change in dietary patterns, physical activity, and tobacco cessation. Some examples of appropriate interventions are promotion of breastfeeding, restriction of fat and trans-fats, avoidance of high-calorie foods, strict legislation against tobacco, encouragement of physical activity and games in schools, and provision of facilities for sports.[4] Universal steps to neutralize factors, which may be initiators of onset of dyslipoproteinimia in early life, however, may not be acceptable to the public. This is to be expected, as individuals tend to choose popular trends over pragmatic ones! This can be handled only by sustained and concerted public health education.{Table 1}

 SUMMARY



It is quite apparent that most of the attributes in the primordial approach belong to the field of medical nutrition and public health. They are far remote from the domain of a cardiologist or endocrinologist or internist or lipidologist, the specialties, which are traditionally responsible for treating dyslipidemia. However, the importance of such simple measures cannot be overemphasized. Moreover, the cost benefits ratio of primordial prevention of dyslipidemia would probably far outweigh the cost of intervention-centric primary, and more particularly secondary and tertiary approaches. Responsibility for the promotion of primordial prevention should be shared by all stakeholders from society and polity, and not left only to healthcare and medical professionals.

It is time primordial prevention is given the respect it deserves, irrespective of the domain we are primarily involved with. This editorial is a step in this direction.

References

1Porta M. Dictionary of Epidemiology. New York: Oxford University Press; 2008.
2Available from: http://www.afmc.ca/pdf/AFMC Primer-on-Population.Health-2013-08-14.pdf. [Last accessed on 2015 Jun 22].
3Pandav CS, Yadav K, Srivastava R, Pandav R, Karmarkar MG. Iodine deficiency disorders (IDD) control in India. Indian J Med Res 2013;138:418-33.
4Zachariah JP, Johnson PK. Pediatric lipid management: An earlier approach. Endocrinol Metab Clin North Am 2014;43:981-92.