PRIMARY PREVENTION OF CORONARY ARTERY DISEASE (REVIEW)

Abstract

Coronary heart disease (CHD) is a major cause of
mortality and morbidity around the world. It is
increasing in the developing world and in countries
belonging to the former Soviet Union. It is estimated
that worldwide deaths from CHD will increase 100%
in men and 80% in women from 1990 to 2020.The concept of prevention has been around for a long
time. Medical writings of as early as 2500 BC refer to
the practice of prevention.Homogentisic acid co enzyme -A reductase
inhibitors called statins have undergone many
randomized primary prevention trialsWOSCOP,
AFCAPS/TexCAPS39, 4S showing reduction in
cholesterol and some increase in HDL level in the
blood15-17.Sedentary life style is associated with increased risk
of coronary heart disease 26. A 45 minutes brisk walk
on most days of week appears to give enough benefit
for coronary risk27-28.In conclusion there are three broad key groups of
patients who require intensive primary prevention for
CHD. The first group includes patients of 10 year
CHD risk > 20% on Framingham scoring table
(Table 1). The second group is of diabetic patients.
The metabolic and lipid abnormalities in diabetics
,place them at high risk of CHD. These two groups
are considered to be CHD risk equivalents. That is,
their 10 year risk is similar to 10 year risk of an
individual with CHD. A third group of patients
known as of metabolic syndrome,(table-3) is also at
markedly high risk of CHD and requires intensive
primary prevention. The measures to bring down 10
year risk of CHD in these three groups include life
style modifications and drugs. The life style
modification include an array of steps to target diet,
weight, smoking, physical activity, lipids and BP.
These life style changes are to be employed prior toor along with drug therapy to achieve optimal goal of
primary prevention.