Population Strategies of Cardiovascular Disease Prevention: Scientific Base, Rationale and Public Health Implications

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Abstract
Congruence of evidence from all medical research methodologies has established the major causal influences in cardiovascular disease. Causation thus established, epidemiological observations are the best available evidence on which to base estimates of the potential of preventive strategies. From population comparisons we learn that some countries have little cardiovascular disease; therefore, prevention is a reality. From mortality surveillance we learn that the disease processes are highly dynamic. Parallels between cardiovascular disease and major non-cardiovascular disease mortality trends suggest that they have common causes and that common preventive strategies may be effective for both. From migrant studies we learn the predominant contribution to population risk of environment and culture. From population surveys we learn that risk characteristics for cardiovascular disease are mass phenomena, therefore they require mass preventive approaches. Follow-up studies in cohorts provide evidence of the risk attributable to elevated risk characteristics and the potential for preventive strategies in high risk societies with high disease rates. Clinical trials indicate the effectiveness of interventions in high risk individuals, the relative safety of such efforts and that cardiovascular disease prevention effects emerge in a very few years. Public health trials demonstrate that communities can mount and maintain effective preventive programs and what programs work best. Studies in youth indicate that risk of adult disease starts early and that an optimal prevention program would seek to prevent elevated risk in the first place.