CHAPTER 9 Chronic Disease Prevention diabetes together exl about 87% of bronchitis, and pneumoconiosis constitutes the third leading disease(CHD)risk. However, the impact ng these cause of death in the United States after heart disease and risk factors has variable impact on total ri mple, cancer. An enormous portion of this toll is directly related for CAD, cigarette smoking increases the risk for smokers by to tobacco and is thus preventable with tobacco avoidance. 23 mg/dL of serum cholesterol in men age 55 to 64 reduced prevention is thus an occupational health issue(see Chapter congestive heart failure( CHF)risk by 25%.A 5-mm Hg 22). Asthma, an important chronic condition of the upper change in diastolic blood pressure decreases CHD risk by airway, is a relatively uncommon cause of mortality but an 21%. Also, risk factors have different weight on different important cause of morbidit manifestations; dyslipidemia is a stronger risk factor for Nonmodifiable risk factors for chronic pulmonary disease CAD and peripheral artery disease(PAD) than for stroke include age and certain genetic disorders, such as a and CHE, hypertension is more important for stroke and antitrypsin deficiency and cystic fibrosis. Modifiable risk CHE, and smoking has the strongest impact on PAD risk factors include exposure to airborne toxins caused by pollu These risk factors do not act independently, and other tion, occupation, or tobacco smoke factors, such as stress, socioeconomic status and famil Tobacco avoidance and smoking cessation are top priori story are often not captured in these studies. Also, concen ties in the prevention and treatment of chronic pulm trating on one risk factor at a time carries the risk of under nary ases. There is no standard screening for pulmonar estimating cardiovascular disease(CvD)risk in patients disease. The USPSTF recommends against screening for with multiple marginal risk factors. The best way to estimate COPD" and currently is noncommittal about lung cancer risk is to use validated total risk score such as the Framing- screening, a subject of ongoing study prone to change ham risk calculator, which allows one to estimate the 10-year Secondary prevention thus relates to management of isk for CVd based on a combination of age, gender, and early-stage disease to prevent progression. Pharmaco- risk factors levels. In the past, there was a different risk cal therapy is prominent in such efforts, notably antinflam culator for CAD, stroke, and CHE. In 2008 a risk score for matory drugs (e.g, steroids) for asthma, COPD,and general CVD risk was published, the Framingham Heart chronic bronchitis. Tertiary prevention may include home Study general cardiovascular disease: 10-year risk, which oxygen for patients functionally limited by hypoxemia performs as well as the individual disease calculators. This along with medications to manage symptoms and prevent score also provides a risk age, the biologic age that corre- progression, and pulmonary rehabilitation after decom- sponds to the risk level of a patient, which is useful in com- pensation. Both the CDC and the American Lung Asso municating risk to patients. For example, if a patient is 40 ciation provide patient-friendly guidance online. The years old but his risk age is 80, his cardiovascular risk is as National Heart, Lung, and Blood Institute(NHLBI)provides high as if he were 80 years old. (A discussion of comprehen- a useful source of regularly updated information for health ve cardiac risk modification is beyond the scope of this professionals Epidemiologic research reports that at least 80% of all ancer CAD is preventable by addressing a short list of lifestyle related risk factors, notably dietary pattern, physical activity Unlike most chronic diseases, which pertain to a particular pattern, and tobacco use. Similar risk reductions are likely organ system( e. g, heart disease, stroke, pulmonary disease, ible at later stages with pharmacologic management of arthritis, diabetes), cancer-the second leading cause of risk factors, such as antihypertensive medications, statins death in the United States"--can affect any organ or tissue cholesterol-lowering drugs) and other drugs for dyslipid in the body and is relatively common and potentiall emia,and platelet inhibition with aspirin. The emphasis for Thus the topic is vast; comprehensive detail is availabl prevention is on lifestyle behaviors before the development where, notably oncology textbooks and journals. The and progression of risk factors, shifting toward pharmaco important facts about cancer include the following therapy as risk factors progress See Table 19-3 on studentconsult. com for a summary of Cancer is acknowledged to be substantially (up to 60%) lipid management recommendations of the National Heart Lung, and Blood Institute of the nih Cancer is not the unpredictable threat that the public The field of cardiovascular medicine evolves rapidly, and tends to believe it is thus readers are referred to the peer-reviewed literature and ancer development is a predictable process, anal authoritative websites for up-to-date information regarding to the progression of atherosclerotic plaque leading to clini epidemiology, prevention, and treatment. Key areas at cally significant coronary disease. The steps of that process resent include the detection and management of cardiac span years to decades, with opportunity for effective preven risk factors in adolescents and children; the optimal use of tion(Table 19-2). Initiation refers to the development of a tatins in men and women for primary prevention; the utility potentially carcinogenic( cancer-causing )mutation. Promo- of diverse biomarkers of cardiac risk; and the incremental tion refers to the growth of cancer cells, before any clinical tility of various risk assessment modalities, such as coro symptoms or signs develop. Expression refers to the first nary computed tomography(CT)imaging clinical evidence of the presence of cancer. Nonmodifiable risk factors for cancer include age and Chronic Lung dis 8 ease predisposing genetic mutations, some of which are preva- lent, important, and well known(e.g, BRCA). Modifiable Chronic lower respiratory tract disease, including chronic risk factors include diet, physical activity, body weight obstructive pulmonary disease (COPD), emphysema, tobacco use, exposure to infectious agents, and toxins