Preventive cardiology, till now has described the risk factors of coronary heart disease with a range. The range included the highest to the lowest limits of the particular risk factors. As it is convenient, most of the patients tried to maintain themselves at the highest of the level. For example, the highest range of serum cholesterol is 130 mg/dl to 200 mg/dl. Most of the doctors and patients who have about 200 mg/dl are very happy and consider themselves completely safe. SAAOL recommends 130mg/dl. The idea is to look for the best of the possibilities.
The second problem or preventive cardiology is the absence of improvement. Even after following instructions, people still would get heart attacks that would break their determination to follow the advice after some time. Mild to moderate changes were not enough to make them compliant in the long run.
Aggressive prevention aims at reversal and not just slow or no progress. Now it is a proven and accepted fact that the blockages can be reversed. Even if the blockage goes down by 1-2%, there is a tremendous symptomatic improvement and the patients are completely protected from a heart attack.
The third fault of preventive cardiology is the lack of importance given to stress and its management. Though stress is today considered the major reason for heart disease, because of its non-measurement of (in terms of clearly defined units like kilograms, milligrams, or milliliters) medical science so far has not given proper importance to this most important parameter. Stress management, against has not been included as a part in the control of heart disease. This needs to be done immediately.
The fourth and the main fault of preventive cardiology is the absence of practical instructions and guidelines for the patients. Most of the instructions were ambiguous. When we know that oils are triglycerides or fats and are the apparent causes of arterial blockages then they should be clearly forbidden. We should also teach the patients how to cook without oil and yet make it tasty. In the absence of a viable alternative, the instructions become redundant. Thus, the need is not only clear instructions but also the evolution of a complete package, which can be followed by the community in a practical way. This should not be confined to one or two risk factors but should include all the possible risk factors of heart disease.
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