36561 - Primordial Prevention A Perspective from the...

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Primordial Prevention – A Perspective from the Bogalusa Heart Study G. Berenson MD, for the Bogalusa Heart Study Group. Tulane Center for Cardiovascular Health
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Primordial Prevention There is about to be a revolution in cardiovascular health care, better an evolution to one with emphasis on prevention in early life. Until now, emphasis has been on secondary prevention of patients with known CV disease, coronary artery disease and hypertensive cardiac and renal disease. Yet, primary prevention of individuals prior to a clinical presentation of cardiac events has long been of interest with the landmark VA hypertension study (1) by Fries and the Multicenter Coronary Drug Project (2).
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Secondary prevention The emphasis on secondary prevention has been sparked by advances from the pharmaceutical industry, particularly with the development of statin drugs, as an outgrowth of the Nobel Prize to Goldstein and Brown. Equally so, are tremendous advances with the development of antihypertensive agents. But, it is only recent that I have heard the concept of Primordial Prevention being advocated. This entails the prevention of the occurrence of CV risk factors, as pioneered by the Framingham study. William Kannel came up with the term in the early years of Framingham, and they have stuck.
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Concept of Primordial Prevention The Concept was suggested by Tom Strasser from the World Health Organization (3) , in terms of prevention strategy. This is a logical approach, since Geoffrey Rose raised the issue of risk in terms of “sick individuals vs sick populations” (4) . I participated in two WHO and two American Health Foundation symposia , the latter held by Ernst Wynder, and all indicated the need to address risk factors in early life (5). For me, it was these meetings that gelled the concept of primordial prevention, enunciated by Strasser.
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Prevention The consideration of primordial prevention is the essence of population studies at the level of children , that now go back almost 40 years. The Muscatine study was begun by Bill Connor who originally suggested to me to “Pick a Community”, rather than a hospital- based population, after our original grant application, based on a population of children enrolled in a psychology study at the Big Charity Hospital in New Orleans, was turned down by NHLBI as an award for a Specialized Centers of Research – Arteriosclerosis (SCORA). This rejection
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36561 - Primordial Prevention A Perspective from the...

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