Abstract
New emphasis is placed in preventive cardiology on the concept of prevention of cardiovascular (CVD) risk factors in the first place: Success would make the risk factors themselves rare in the population, and even early pre-adult atherosclerosis would become less common and less extensive. This concept raises several practical considerations which will be illustrated by selected data. (1) Risk factor prevention includes "primordial prevention, " conceived by Strasser; but where primordial prevention is too little or too late (the usual case?), prevention of the risk factors must address the already-affected population. (2) Risk factor prevention includes an important focus on youth but must extend to both earlier and later ages to achieve its goals; this is because, on the one hand, the risk factors and atherosclerosis may be advanced already during youth and, on the other hand, risk factor development progresses well beyond youth. (3) Risk factor prevention requires that several socially institutionalized gaps be bridged --- such as those between childhood and adulthood, school and workplace, or pediatrics and adult medicine; continuity of preventive policies and practices is needed instead. (4) Risk factor prevention depends on better understanding of the determinants and early development of the risk factors; causal relations between preconditions for risk factor development and progression of the risk factors themselves need to be firmly established, just as the risk factors have long since become strongly linked to CVD events. (5) Risk factor prevention should be measured by reductions achieved in rates of progression of the risk factors, in either their absolute levels or rates of change with age, or in the frequency with which they reach levels requiring treatment. (6) Risk factor prevention requires further research through both observational studies and intervention trials, to be followed by long-term demonstrations to evaluate the effectiveness and costs of intervention. J Epidemiol, 1996; 6: S65-S69.
