ReviewEarly intervention and prevention of myocardial infarctionPais, Prem SAuthor Information St John's Medical College, Bangalore, India Correspondence and request for reprints to Professor Prem Pais, Dean and Professor of Medicine, St John's Medical College, Sarjapur Road, Bangalore 560034, India Tel: +91 80 2206 5030; fax: +91 80 2552 3416; e-mail: [email protected] Journal of Hypertension: April 2006 - Volume 24 - Issue - p S25-S30 doi: 10.1097/01.hjh.0000220100.50272.b0 Buy Metrics Abstract Although there has been a decline in the incidence of ischaemic heart disease in Western Europe, North America and Australia/New Zealand, it remains a major cause of morbidity and mortality worldwide due to rapidly increasing incidences in developing countries. Prevention is key to reducing the burden of this disease. The INTERHEART study performed in 52 countries around the world has shown that the major risk factors are tobacco smoking, elevated apolipoprotein A, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, low fruit and vegetable intake, physical inactivity and alcohol consumption. Strategies for prevention by reducing risk factors are applicable universally. Individual healthcare providers can implement primary and secondary preventive measures to individual patients. Primary prevention involves the avoidance of disease in high-risk subjects free of disease, whereas the purpose of secondary prevention is to avoid recurrence of myocardial infarction. The general principle is to encourage improved and proven lifestyle measures and to prescribe evidence-based effective medications. Primary prevention requires greater investment and planning to identify people at high risk, plus the implementation of life-style intervention and pharmacological prevention. In both situations, strategies will have to be tailored to suit individual countries and economies. Life-style measures (i.e. sensible diet, physical exercise and smoking cessation) are effective and need to be promoted. Compliance with preventive measures is achievable. Primordial prevention, which involves reducing the prevalence of risk factors, rests mainly on public education, media, legislation and government policy, and is very dependent on individual governments’ commitment and determination. It requires promoting a healthier life-style in the population as a whole by encouraging people to seek alternatives and making them available. © 2006 Lippincott Williams & Wilkins, Inc.