Prevention of disease with pharmaceuticals

The idea that diseases such as cardiovascular disease and cancer can be pre vented by taking a 'pill' is attractive to many people. Chemoprevention is an established method in the primary and secondary prevention of cardiovasc ular disease such as myocardial infarctions and stroke, Clinical trials hav e demonstrated beyond reasonable doubt that both fatal and non-fatal corona ry events and strokes can be prevented. Antihypertensive drugs have been sh own to be effective through clinical trials in preventing myocardial infarc tions, stroke and other cardiovascular morbidity and mortality. Statins are commonly used to lower the blood cholesterol concentration, and aspirin is widely used to prevent occlusive vascular disease. Aspirin and other non-s teroidal antiinflammatory agents have shown promise in the chemoprevention of colorectal cancer. While observational epidemiological studies have cons istently suggested that diets rich in antioxidants such as p-carotene might be useful in preventing coronary heart disease and cancer, the published r eports of randomized trials clearly indicate that beta -carotene supplement s are of no value in persons of high risk for such conditions. Although the chemoprevention of cancer is decades behind that of cardiovascular disease , there is no reason to believe that progress in cancer chemoprevention wil l differ substantially from that in cardiovascular disease. Better understa nding of the molecular steps critical to carcinogenesis should open new ave nues for cancer chemoprevention.