Khapre M, et al. J Datta Meghe Inst Med Sci Univ 2019;14:1-5
Khapre M, et al., conducted a review to analyse the brief of study on CHD by reviewing the global data of preventive strategies of CHD and also difference was observed in the research
After the year 2005, articles published preferably with key search terminologies like “Cardiovascular* OR Coronary Heart disease OR Atherosclerosis OR Ischemic heart disease OR Myocardial* OR Heart Attack OR “angina,” “heart” AND “Prevention* OR treatment OR Drug OR Diet OR Physical activity OR Lifestyle”, were broadly investigated in all the literature databases such as PubMed, Embase, Google scholar, Journal seek, INDMed, and Cochrane. Additionally, it was also searched under MESH heading. Whereas, large cohort study or meta-analysis restricted to the past 15 years, was included in the study.
Global Evidences of Prevention of Coronary Heart Disease
Population attributable risk (PAR) of CHD for various risk factors is 35.7% of smoking, 49.2% of increased ApoB/ApoA1 ratio, 17.9% of hypertension (HTN), 9.9% of diabetes (9.9%), 20.1% of abdominal obesity, 32.5% of psychosocial factors, 13.7% of fruits and vegetables, 12.2% of lack of regular physical activity irrespective of age, sex and ethnicity. Accordingly, these above risk factors may be estimated for 90% and 94% of PAR in males and females.
Primary prevention
Lifestyle modifications like cutoff smoking, weight management, diet, and physical activity were included in primary prevention.
Secondary prevention
The initial identification of disease development and guidance of interventions to limit the evolution of the disease were included in the secondary prevention
Smoking – Patients who have cut-off their smoking habit reduced 35% of their mortality rate and 36% of mortality or nonfatal myocardial (re) infarction. Following a coronary event, the relative risk ratio of mortality was 0.13 to 0.72 for quitters vs. permanent smokers, while, the relative risk ratio of MI was 0.23 to 0.68.
Weight (Obesity) – Strong association was observed between obesity and major cardiovascular risk factors like raised BP, glucose intolerance, type 2 diabetes, and dyslipidemia. As compared to the lowest body mass index category, the heaviest death relative risk due to CHD was 1.57 times. Various studies have reported that reduction in weight up to 5% may be associated with 8%–30% raised HDL, 8%–21% reduce LDL and improved cardiac fitness.
Diet – As compared to reducing overall fat intake, replacing saturated and trans-unsaturated fats with monounsaturated and polyunsaturated fats seems to be more effective in preventing CHD events. Decreasing intake of dietary cholesterol by 100 mg a day leads to 1 % reduction of the serum cholesterol. It was recommended to reduce salt intake to <6 g.
Physical Activity – Berlin and Colditz reported that as compared to people with active lifestyle, relative risk of death from CHD was 1.9 (95% CI: 1.6–2.2) for people with sedentary occupations. It was recommended by WHO that people must do at least 150 min of daily physical activity (moderate to week for the maintenance of health.
Diabetes – As defined by the WHO, men with the metabolic syndrome were 2.9–3.3 times more likely to die of CHD after adjustment for conventional cardiovascular risk factors. Association between 1% increases in glycated hemoglobin level with a 14% increase in the incidence of fatal or nonfatal MI was reported by the UK prospective diabetes study.
Hypertension – Various trials reported that lowering BP reduces the number of cardiovascular events in those patients with high cardiovascular risk, with BPs in the range 140–160 mmHg (systolic) and 90–100 mmHg (diastolic). The Joint National Committee 8 recommended that target BP for patients with CHD or CHD equivalents like diabetes mellitus, chronic renal disease, peripheral arterial disease, carotid artery disease, and abdominal aortic aneurysm as <140/90 mmHg, whereas for general individuals, or those <60 years is 150/90 mmHg.
Dyslipidemia – Various meta-analysis reported the advantages of lipid-lowering agents in relative reduction by 60% of coronary events, coronary revascularization, CVD mortality, nonfatal stroke, and mortality in both primary and secondary prevention.
Thus, obesity, diabetes, HTN, and dyslipidemia develop dangerously faster. Rather than reducing fat intake, replacing saturated and trans-saturated fat with monounsaturated fatty acid and polyunsaturated fatty acid should be established.
