CHD is the leading cause of death of adults on the planet. The morbidity and financial cost of this epidemic disease is climbing daily. If this was an infectious disease, states of emergency would be declared world wide! Its logical and makes medical sense, that screening for the disease and its pre-cursor risk factors, is potentially likely to have significant impact on CHD and other risk factors like DM and OWOB, because we have management and treatments, more effective now.
In my post on CHD in women, I made the case that current knowledge indicates ignoring the common risk factors potentially creates a fetal enviroment via epigenetic processes, that may perpetuate risk factors or premature death from CHD for the progeny. More proximate is low birth weight. Hypothetically the mother may have one or ten children. So attention by screening has access to a group, while offering CHD screening to the male, will have significantly less impact.
As a Cardiologist I believe with our current knowledge, there could not be a better time to screen and intervene as indicated. In the 47 years since graduation, research results, pressure groups, commercial interests, ‘health bodies’, Government directives have made interpretation very difficult and confusing for medical doctors, let alone the public and patients. Not that medicine has not attended to risk factors as best we can, but the cholesterol story was screwy biology and just as difficult to manage clinically.The Lipid Hypothesis was largely created and driven by Ancel Keys, with powerful support from a collection of lobbyists with deep pockets and Government backing.It must never happen again and I and many others in medicine ,was hijacked and pressured when at best, we were unconvinced of the hypothesis.For medical students and junior doctors, the simple and obvious question was:’why would one of our most important structural and functional compounds, manufactured almost entirely by us, cholesterol, suddenly in the 2oth century become a pandemic disease producing toxin? Why would saturated fat like wise, when we had been consuming it for millions of years since we became omnivores and sort it preferentially in prey?The brain, bone marrow and organ food are examples.
Too much decision making was and is today, being made by those without the medical expertise to do so, I refer to as the ‘Dumbing Down of Medicine’. Decision making on disease is too often determined by politicians, bureaucrats, lawyers, bankers, pressure groups, uncle Tom Doodle and All, where if we are asked to attend, you distribute medical dictionaries, Greys anatomy and all specialist texts and interpret any data for them.How can you get an informed rational consensus on your diseases from this disparate group? It must occur in all areas of expertise in science.The design is faulty.
Pressure groups have agitated screening for cancers; cancer of the breast, cervix and bowel. As I indicate in other posts, mortality from these cancers in total is only 30-40% of that from CHD!! When it comes to public spending for disease, hard medical facts can be drowned by the tears of emotion and perceptions of the public and administration. Screening for CHD by the patients GP would potentially be cost effective not just for CHD, but OWOB, DM, Hypertension too.