Primary Prevention of Cardiovascular Disease: Community Nutrition Programs

Primary prevention of cardiovascular disease from the community nutrition point of view. Interventional programs

- CVD and cerebrovascular disease are the 2 main forms of cardiovascular disease, major cause of disability and premature death throughout the world

• - Prevention, primary and secondary treatments helped to decrease these levels in the last years
• - Primary prevention aims to decrease the incidence of CVD by manipulating risk factors (intervention BEFORE the disease develops)
• - Underlying pathology: atherosclerosis
• - Aspirin: Decreases risk of cardiac events in people > 40y, post-menopausal and young people with multiple cardiovascular risk factors

WHO Goals: to prevent CHD events by lowering cardiovascular risk. The recommendations assist people to:

• - Quit tobacco use, or reduce the amount smoked, or not start the habit
• - Make healthy food choices
• - Be physically active
• - Reduce body mass index, waist–hip ratio/waist circumference
• - Lower blood pressure
• - Lower blood cholesterol and low density lipoprotein cholesterol (LDL-cholesterol)
• - Control glycaemia
• - Take antiplatelet therapy when necessary

Risk factors:

- Non modifiable: Age (male > 45y; female > 55y), Sex, Race, Family history (1st degree), Previous cardiovascular event

- Modifiable: Smoking, Hyperlipidemia, Hypertension (> 140/90), Diabetes, Obesity, Physical inactivity

Interventions: Smoking Cessation: Smoking is associated with decreased levels of HDL, increased platelet aggregation and fibrinogen levels, endothelial dysfunction, etc... leading to plaque formation (atherosclerosis). Individual Interventions: support and counseling, nicotine replacement therapy, etc. Community level: advertising campaigns, warnings on cigarette packets, legislation (e.g. smoke-free public areas, increased taxes, etc)

Global risk

Blood pressure:

- HT can lead to endothelial damage, migration of lipoproteins into the endothelial wall and eventual plaque rupture. Risk factors: obesity, increased alcohol and salt intake and lack of exercise. Management: Risk factor for developing: DM 2, HT, dyslipidemias, CVD, etc... Abdominal obesity is more significant than generalized obesity. These patients should be advised to reduce their body weight (maintain a BMI between 20-25). Management: Proper diet, Increased physical activity, Community interventions – increased spaces and areas for physical activity, higher taxation of unhealthy foods, mandatory physical activity (e.g. Japan)

Blood glucose control: DM increases CVD mortality 2-3x in men and 4-6x in women. In a patient with DM Type II metabolic disturbances lead to hyperinsulinemia, HT, central obesity and dyslipidemia leading to atherogenesis. Adequate diet and physical activity can also help maintain proper control

Cholesterol reduction: Reduce consumption of saturated fats and increase PUFAs, fruit, vegetable and fibre intake. Statins treat high cholesterol and in combination with dietary modification can reduce total cholesterol by 20% and LDL by 30%. Desirable lipid values: assessment. Framingham risk chart for patients without diabetes. Helpful in estimating the 10y CHD risk for adults who do not have CVD or diabetes. RF in Framingham’s calculation: gender, age, total chol, HDL chol, systolic blood pressure and cigarette smoking

Obesity:

• Essential HT cannot be reversed, but can be controlled with appropriate medication
• Secondary HT (with identifiable causes) should be diagnosed and where possible, the underlying cause should be treated

Effective interventions:

• - UK: Government promoted program in relation to the food and drink-manufacturing industry successfully reduced salt content in almost 1⁄4 of manufactured foods over several years
• - Mauritius: Cholesterol reduction was achieved largely by a government led effort switching the main source of cooking oil from palm to soya bean oil
• - Japan: Government led health campaigns have greatly reduced salt intake and together with increased BP treatment have reduced blood pressure in their population and stroke rates have fallen more than 70%
• - Finland: Community based and national interventions, including health promotion and nutrition interventions, led to population-wide reductions in cholesterol and other risks closely followed by decline in heart disease and stroke mortality

Europe:

USA: A decrease in saturated fat intake in the late 1960s began the large decline in CHD deaths seen in the last few decades there

New Zealand: Introduction of labeling logos for healthier foods led many companies to reformulate their products. Benefits included large decreases in the salt content of processed foods

European Action Plan for Food and Nutrition Policy (2007–2012) and the Global Strategy on Diet, Physical Activity and Health (2008–2013). Slightly more than two thirds of countries have a policy or strategy on non-communicable diseases (NCDs). Policies, strategies or action plans commonly address the risk factors than diseases