From Nature, 9 June 2021:
For preventive cardiologist Michele Mietus-Snyder, the quest to understand and address the early causes of heart disease is like going down the rabbit hole in Lewis Carroll’s Alice’s Adventures in Wonderland.
“When I’m seeing my adolescent patients, I’m not just trying to prevent heart disease for that child, but for that child’s children,” she says.
Initially, risk factors might seem to be an individual’s lifestyle — poor diet or lack of physical activity, for example. But delve deeper and it becomes clear that heart disease can be set in motion long before these lifestyle decisions are made. “The foundations of cardiovascular risk are laid before birth,” says Mietus-Snyder, at the Children’s National Hospital in Washington DC.
The endpoints of cardiovascular disease are exceptionally well characterized. This is unsurprising, given that ischaemic heart disease is the single biggest cause of mortality worldwide, responsible for 16% of all deaths. But the paths that lead to that endpoint are much less well understood. What is becoming apparent is that many people are born already holding a poor hand of cards when it comes to their cardiovascular health, thanks to genetic and ‘epigenetic’ factors, parent’s and grandparent’s lifestyles and exposures, conditions in the womb and growth patterns in the first year of life. That doesn’t mean, however, that they are doomed to disease. Understanding these influencing factors means that interventions to reduce risk can be developed and applied early, long before processes have gone past the point of disease prevention. Read more.