2007 Ancel Keys Memorial Lecture—Toward a Global Solution for CVD—Can We Prevent the Majority of Premature CVD in the Next 25 Years?
Much has been learned about the risk factors for cardiovascular disease (CVD), and recent studies suggest that the majority of myocardial infarction and strokes can be accounted for by currently known risk factors. Furthermore, modest and relatively short-term changes in these risk factors can each reduce the risk of future events by about one quarter. Collectively, the use of several drugs or approaches in combination (eg, smoking cessation, lipid lowering with a statin, blood pressure lowering with a diuretic and an angiotensin-converting enzyme inhibitor, β-blockers and aspirin in secondary prevention) can in theory reduce the risk of future events by up to 80%.
The next decade or two will see intensive research into the societal and environmental causes that influence unhealthy behaviors so that societal and policy changes can be developed on the basis of evidence. In the long term, these changes will reduce population levels of risk factors and reverse the marked increase in CVD that has occurred in the past century. However, these changes are likely to take some decades. In the near term (the next 10 to 15 years), realizing the full benefits of currently proven therapies (ie, knowledge translation) is the immediate challenge. Development and evaluation of a polypill are critical and represent the culmination of 3 decades of progress. If proven in large randomized clinical trials to have the large benefits expected, the use of the polypill could lead to a substantial impact on the global burden of cardiovascular disease in most countries. Given that more than 80% of the global burden of CVD occurs in low- and middle-income countries, where the rates are increasing, development of inexpensive and widely applicable strategies for prevention is critical and could lead to the avoidance of the majority of premature cardiovascular disease in the world. This goal is achievable in the next 3 decades.