More than a decade ago, a strategic committee chaired by the current president of the American Heart Association (AHA), Dr. Donald Lloyd-Jones, proposed a paradigm shift in cardiovascular medicine: move the focus from the battle against cardiovascular disease (CVD) (although legitimate) to the promotion of cardiovascular health. In order to achieve this strategic goal, ideal cardiovascular health had to be defined. The committee therefore proposed seven metrics: three biological risk factors (normal blood pressure, cholesterol and glucose levels) and four behaviors (not smoking, healthy diet, be physically active and normal body mass index), the so-called Life’s Simple 7. Population studies then revealed a stunning statistic: less than 1% of the population met these criteria of ideal cardiovascular health.
In a recent update published in Circulation, Dr. Lloyd-Jones, along with AHA past president Dr. Mitchell Elkind and president-elect Dr. Michelle Albert, co-signed a superb editorial highlighting the importance of primordial prevention by avoiding the development of adverse levels of CVD risk factors. This is a much more ambitious goal than primary prevention, which rather focusses on the identification and clinical management of CVD risk factors when present. Using hypertension as an example, the authors make the point that although individuals with elevated blood pressure restored to normal levels (<120/<80 mmHg) following treatment clearly get clinical benefits, they nevertheless remain at higher risk than those who always had a blood pressure <120/<80 mmHg.
On that basis, the authors emphasize that in order to optimally prevent CVD, we must not only treat individuals following guidelines, but we must also implement social and policy changes to help prevent the development of adverse risk factors at the first place, once again showing the critical importance of promoting primordial prevention.