The societal context of coronary artery disease
Department of Internal Medicine and Cardiology, Faculty of Health Sciences, Aarhus University Hospital, AAS, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark
Corresponding author. Tel: +45 8949 7600; fax: +45 8949 7619. E-mail address: Ole.Faergeman{at}aas.auh.dk
Our success in reducing risk for coronary heart disease events with statin therapy should not serve to deflect our attention from our understanding of the nature of atherogenesis and what that implies about efforts to eradicate atherosclerosis. The recently reported Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) trial showed that a statin regimen that lowered low-density lipoprotein cholesterol (LDL-C) more effectively was associated with significantly better prevention of cardiovascular events than a regimen that was thought to have greater pleiotropic effects. On the one hand, such findings should serve to refocus attention on the primary clinical goal of lowering LDL-C in our at-risk patients; on the other, it should refocus attention on the conditions that make atherosclerosis so prevalent in modern society. From the point of view of eradicating or markedly reducing prevalence of atherosclerosis, political efforts are required to enhance education and to fashion changes in policies regulating the agriculture, food, and tobacco industries. The alternative is to fully embrace the medicalization of society, whereby we focus on efforts in biotechnology and industrialized medicine to address the consequences of diseases promoted by industrialization and urbanization.
Key Words: Coronary heart disease • Atherogenesis • Low-density lipoprotein • Agriculture • Biotechnology • Industrialization