Setting the Agenda for Preventive Cardiology
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- cardiovascular diseases
- myocardial infarction
- preventive cardiology
- risk assessment
Preventive cardiology is a spontaneously emerging subspecialty with a broad base of support from multiple disciplines but no obvious consensus on its logistical, educational, and disciplines boundaries. Here, we examine the origins and current status of the field and provide a roadmap for its future success as a subspecialty.
What Is Preventive Cardiology?
To some, it is a general concept encompassing a range of interests so wide to include basic research, population studies, community medicine, and public policy work. To others, it is a philosophy that informs and defines an aspect of a more general clinical practice stance, be it general cardiology, endocrinology, or internal medicine. To us, practitioners of this clinical art, it is a discipline in its own right and worthy of attaining subspecialty status. Atherosclerotic cardiovascular disease (ASCVD) remains the leading killer in the world, and yet we all know it is largely preventable.1 The notion of dedicating significant resources to ASCVD prevention in the clinical setting, although of intuitive value, poses challenges of political and logistical nature. Yet, these challenges must be overcome as the threat we face is colossal. All of us after a certain age are at measurable risk of heart attack or stroke. This brief perspective will examine the origins of what is currently known as preventive cardiology, review the current status of this discipline in its myriad forms, and provide a call to action for its future if it is to evolve as a defined subspecialty.
Scientists from diverse backgrounds have been interested in the link between cholesterol and ASCVD for over a century. In 1913, Nikolai Anitschkow fed pure cholesterol to rabbits and demonstrated the development of hypercholesterolemia and extensive aortic atherosclerosis.2 The Framingham Heart Study, launched in 1948, established the principle of ASCVD risk factors, contributory agents with no single sufficient cause. …