Primary vs. Secondary Prevention
I want all of my patients to have a more sophisticated understanding of cardiovascular medicine. Knowledge is Prevention.
There are two terms you need to be familiar with regarding cardiac prevention:
Primary Prevention and Secondary Prevention.
*Primary Prevention = preventing a first heart attack, stroke, stent or bypass. *Secondary Prevention = avoiding a recurrent cardiovascular complication.
Almost everything you read about regarding cardiac prevention such as the benefits of aspirin, statins, lowering BP, lowering blood sugar, diet/weight loss, exercise--involves secondary prevention. In other words, if a person suffers a heart attack or stroke or requires a bypass, stent...then lowering those risk factors will dramatically increase your chances of living a long, healthy life.
The distinction between primary and secondary prevntion is never made clear to patients and many people incorrectly believe that risk factor modification will be effective for everyone, in the same degree. That's just not the case.
For those who have not suffered a heart attack, stroke, or required interventional procedures, risk factor modification is not as effective. There is far less data demonstrating the benefit of risk reduction in primary prevention.
When discussing primary prevention, where there is no pre-existing heart disease, it also matters whether your risk for suffering a heart attack/cardiac death is low, intermediate or high.
If you have a low likelihood of developing future heart disease, you will not benefit (as much) from aspirin, statins, exercise, etc. An example is the recent controversy regarding aspirin. Aspirin will not prevent cardiac death in those who have no CAD or minimal CAD, and result in side effects.
In primary prevention, we must 'know our audience'. What really matters is determining who has heart disease and who does not AND to what degree.
As I have discussed with patients for over 24 years, the American Heart Association and the American College of Cardiology rely upon inaccurate tools such as the ASCVD risk calculator when they should be utilizing the calcium score in stratifying patient risk.
Bottom line: Ask your doctor if you are at low, intermediate or higher risk to develop future cardiac complications. This will determine how the degree of testing, the type of testing, the need for statins, asa, etc.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Gregg Yamada MD FACC
Disclaimer: I hope you find my medical blogs to be pertinent, interesting, thought provoking, and even humorous. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2019. Gregg M. Yamada, MD FACC. All rights reserved.