Prevention of cardiovascular disease
The global scale of the cardiovascular disease epidemic is unquestionable, with cardiovascular disease causing a greater burden of mortality and morbidity than any other disease, regardless of country or population. With demographic change and ageing populations, the prevalence of cardiovascular disease and its risk factors is set to increase. The commonest cardiovascular diseases are atherosclerotic, affecting all arterial territories. The ‘burden of disease’ approach has highlighted the fact that cardiovascular disease and non-communicable diseases are not simply diseases of affluence but affect people of all countries, with enormous costs in terms of public health, healthcare, and overall economies. Coronary artery disease is the leading cause of mortality in all regions of the world apart from sub-Saharan Africa, followed by cerebrovascular disease. It should be noted, however, that there has been a major decline in cardiovascular disease mortality in Western Europe, the US, and Japan over the past 40 years. There are multiple factors underlying these favourable trends but understanding the epidemiology and characterizing individual risk factors for cardiovascular disease has been central in formulating preventive and treatment strategies. The INTERHEART study showed that 90% of cardiovascular risk can be explained by nine easily identifiable risk factors; an awareness of these, and the discovery of novel factors, will continue to serve in the fight to reduce the burden of cardiovascular disease. Geoffrey Rose first championed population-wide approaches versus strategies which target only high-risk individuals. Prevention aims to ‘catch the disease’ upstream, therefore delaying, reducing, or eliminating the risk of coronary artery disease. Surrogate markers for coronary artery disease have emerged in efforts to detect disease at earlier stages, and in order to better understand the pathophysiology. For example, coronary artery calcium scoring is emerging as a marker of future risk of coronary artery disease. Risk stratification scores are increasingly used as tools to individualize a person’s future risk of coronary artery disease in order to better target treatment and prevention strategies.