Preventing the major cause of mortality; a real lacuna of the research

As per WHO health statistics, 63% of the global mortality was due to non-communicable diseases. Out of this 48% was due to cardiovascular diseases where 80% of these occurred in the low and middle income countries.

Of the available 440 Cochrane reviews under the health topic of heart and circulation, only 27 were found to be related to heart disease prevention. Is it either the preventive research were not in full extent or they were neglected in the reviews?

Science of prevention mentions three levels, primordial being prevention of occurrence of risk, primary being prevention of risk cadre to enter into the disease category, secondary being identification of the diseased at the earliest and halting the progress of the disease to complications and finally tertiary being the limiting the already occurred disability due to the disease and rehabilitating them.

Ideally the medical science has to put the efforts over the initial levels of the prevention in research, to foster its findings in the control of disease either the individual or the community. As usual always the truth is bitter. The question is whether our conscience is a problem in the scientific civilization or we were void of the research methods over the prevention and control of diseases.

Of those 27 preventive researches, only the following addresses the primordial to primary level of prevention
• Multiple risk factor interventions for coronary heart disease
• Interventions for promoting physical activity
• Selenium supplements for the prevention of cardiovascular disease
• Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults
• Cutting down or changing the fat we eat may reduce our risk of heart disease
• Interventions for preventing obesity in children
• Community wide interventions for increasing physical activity
• Dietary advice for reducing cardiovascular risk
• Psychosocial smoking cessation interventions such as behavioural counselling, telephone support and self-help interventions are effective in helping people with coronary heart disease stop smoking
• Influenza vaccines for preventing coronary heart disease
Thus it is very limited that suggesting or framing of the guidelines for the prevention of the cardiovascular diseases would be more of opinion sake rather than proper evidence based medicine.

Dr.P.Ganeshkumar MD
Community medicine consultant.