Definitions
Primary prevention can be a population-based approach to prevent disease among communities or an individually based clinical approach to disease prevention, directed toward preventing the initial occurrence of a disorder in otherwise healthy individuals. Primary prevention can be implemented in the primary care setting, and the physician, nurse, physician assistant, pharmacist or patient may initiate a discussion of heart conditions, stroke and vascular cognitive impairment risk reduction. It can also be implemented at a population level using legislative, regulatory and public awareness interventions.
Primary prevention and health promotion recommendations related to heart conditions, stroke, TIA, vascular cognitive impairment and peripheral vascular disease emphasize the importance of screening and monitoring and treating those patients at high risk of a first clinical event. Primary prevention areas of focus include lifestyle (healthy diet, physical activity, being smoke-free, stress reduction and limiting alcohol, recreational drugs and cannabis use), and screening and management of risk factors such as hypertension screening, dyslipidemia screening, diabetes management, and management of atrial fibrillation.
Implementation of primary prevention strategies ideally would involve a Shared Decision-Making conversation between the patient and the provider to ensure the patient’s goals are incorporated to therapy decisions.
Primary prevention also includes the development of strategies to improve population health such as policies that support the population by making healthy choices the easier choices (examples including smoke-free legislation, revised Canada’s Food Guide), and policies that support active and public transportation. These strategies are often led by health-oriented organizations and agencies such as Heart & Stroke, Canadian Cardiovascular Society, Thrombosis Canada, Hypertension Canada, Diabetes Canada, Alzheimer Society of Canada, Health Canada, and national and provincial public health agencies and services.
Secondary prevention is an individually based clinical approach aimed at reducing the risk of a recurrent vascular event in individuals who have already experienced angina, myocardial infarction, heart failure, heart rhythm abnormalities, structural heart disease, stroke, transient ischemic attack, vascular cognitive impairment or peripheral vascular disease.
Secondary prevention recommendations are directed to those risk factors shown to reduce recurrent and prolong survival after vascular conditions, including attention to lifestyle (prudent diet, reduced sodium intake, increased level of activity, maintaining ideal body weight, smoking cessation, and controlling alcohol intake), and management of medical conditions such as hypertension, dyslipidemia, and heart rhythm management (e.g. atrial fibrillation). Secondary prevention recommendations can be addressed in a variety of settings— community-based care settings (primary care and subspecialty care), vascular prevention clinics (generalized or specific to conditions such as stroke, heart failure, post myocardial infarction)emergency care, including emergency medical services, acute care, and rehabilitation. They pertain to patients initially seen in primary care, those who are treated in an emergency department and then released and those who are hospitalized and receive treatment in hospital because of angina, myocardial infarction, heart failure, heart rhythm abnormalities, structural heart disease, stroke, transient ischemic attack, vascular cognitive impairment or peripheral vascular disease.
Recommendations for secondary prevention of vascular conditions should be implemented throughout the recovery phase, including during inpatient and outpatient rehabilitation, reintegration into the community and ongoing follow-up by primary care practitioners. Secondary prevention should be addressed at all appropriate healthcare encounters on an ongoing basis following angina, myocardial infarction, heart failure, heart rhythm abnormalities, structural heart disease, stroke, transient ischemic attack, vascular cognitive impairment or peripheral vascular disease.
Cardiovascular disease is disease pertaining to the heart and blood vessels.
Cerebrovascular disease is disease pertaining to the blood vessel of the brain.
Peripheral Artery Disease is a circulation disorder that is caused by narrowed or blocked blood vessels in arteries located outside of the heart and brain.
Vascular disease refers to cerebrovascular and peripheral vascular diseases that stiffen, narrow or block the intra- and extracranial arteries or peripheral arteries and veins. Broadly speaking, vascular disease encompasses sclerosis, stenosis and occlusion of arteries or veins. Types of vascular disease include peripheral artery disease, carotid artery disease, venous disease, embolism and thrombosis, and aortic aneurysm and dissection. These abnormal vascular changes may result from endothelial dysfunction, inflammation, atherosclerosis, fibrosis or pathological differentiation including arterial plaque formation and venous thrombosis.
