Many of the diseases needing open heart surgery are preventable or at least partially preventable. Others are of degenerative nature and currently not really preventable. We have been pretty successful preventing rheumatic valve disease in our context as a rich country thanks to the precise diagnosis and antibiotic treatment of streptococcal infections (mainly sore throat). Our success in preventing coronary heart disease is less spectacular. Every time when performing coronary bypass surgery it’s inevitable to think of cardiovascular risk factors, such as metabolic syndrome, obesity, poorly controlled / balanced blood fats, smoking, high blood pressure. We and our partners in Interventional Cardiology got pretty good in repairing the various life-threatening sequelae of coronary heart disease (and other diseases, as well), which is without doubt an excellent achievement of modern medicine. In fact, current medicine is primarily focused on precise, diagnosis and effective treatment. With an explosion in understanding physiology and pathophysiology down to cellular, molecular and genetical level, focus is shifting. The emerging medical discipline is prevention. Not only prevention of one or a series of diseases but preventing cells and tissues to stray off their path of healthy function embracing the inevitable biological process by aiming for a healthy aging to the highest possible degree.
Some diseases are not avoidable, this is for sure. These have to be managed in the best possible way. Some diseases, however, are potentially avoidable, this is the focus of proactive prevention. For now we don’t have a magic pharmacological or other bullet in our hands to achieve this goal. We dispose, however already of various approaches, which can potentially help us in achieving some success. This is the domain of proactive prevention.
We should set the semantics clear: we are talking about “primary” prevention as originally thougt. This term is meanwhile associated with the prevention of a specific disease, as the terms “secondary” and “tertiary” prevention are intended to prevent short-, mid- and long-term sequelae after the diagnosis of one specific disease. We will be talking about strategies to promote general health and prevent / postpone cells and tissues from entering in potentially pathological processes which can promote diseases.
Many of the diseases we want to prevent (cardiovascular diseases, diabetes, cancer and dementia among them) are diagnosed with increasing age (see Figure 1).
Figure 1: Incidence rate / cumulative incidence (number of new cases occurring per 100’000 persons/year or cumulative incidence) of major diseases stratified by age. (Google AI, Gemini, 2024).
Either because the aging process itself allows them to develop (see below), or because it takes years of not living healthy to pave the way for their development. Both ways in combination are also possible. Proactive prevention addresses them both.
It all converges on two terms: healthy living (know, understand and apply what science identifies as beneficial for maintaining and promoting our health) and extend our health span (science of aging mechanisms and how to interfere with them to prolong our healthy lifespan).
We will be dealing with both of those subjects in the next posts.