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.