Primordial prevention of cardiovascular disease through applied genetics

Primordial prevention might be considered prevention of the development of disease at its earliest stages or early intervention on risk factors to eli minate increased risk in the first place. In this review we consider how kn owledge of genetic causes of early cardiovascular disease can lead to direc ted screening and better treatment of high risk individuals. While gene the rapy would be the most "primordial" approach to prevention of some diseases such as familial hypercholesterolemia, its practical application remains o n the horizon. Nevertheless, there is much we can do now to prevent early d eaths in genetically high risk patients. Here we consider epidemiology as t he parent discipline for applied genetics and as integral to primordial pre vention. With new knowledge of special susceptibility and new understanding of the interaction of genetics and exposures, prevention of individual hig h-risk in the first place is realizable. We summarize here the known and candidate genes influencing atherosclerosis , hypertension, and thrombosis; their diagnosis; and some useful preventive approaches. MEDPED, an international scheme for detection of risk in medic al pedigrees, is described, along with the cost and social implications of its application as a preventive strategy. (C) 1999 American Health Foundati on and Academic Press.