Primordial Prevention

It is hard to believe that a term has been around since the late 70s and I only heard it mentioned today. Especially boggling because it is related to public health and disease prevention. Well - I know it now and so shall you.

I heard more about stroke today - I realize I blogged about this just a few days ago, but since then I have had the pleasure of making the figurative acquaintance of this physician/scientist/author named Dr. Olajide Williams. He is just phenomenal - his book is Stroke Diaries and he was a guest on Talk of the Nation today. You can hear his conversation on your computer, by clicking this link.

Primordial prevention is a term used with regards to changing adverse disease out comes - i.e death from heart attack or stroke due to cardiovascular or cerebrovascular disease by preventing the DISEASE that precedes the outcome.

Thus, primordially diseases such as obesity, hypertension or diabetes can be prevented by avoiding tobacco, consuming fruits and vegetables and participating in exercise. IF one gets the diseases anyways, because it happens - and family history is a risk factor that cannot be controlled - the primary strategies are to manage and control these diseases so that they do not escalate. [on Talk of the Nation, Dr. Williams was quite emphatic in saying that the lifestyle measures were NOT trivial and that much research exists to show the benefits of exercise, for example, in preventing cerebrovascular disease]

Dr. Williams shared a lot of information today, including the term primordial prevention. He said that 80% of stroke is preventable. I saw an opinion piece he offered on Medscape as well and in that piece he discussed the great disparity of stroke incidence and death for African American men - and death in middle age. This is in large part due to the first degree relative history and the environmental conditions that lead to much higher levels of hypertension or high blood pressure in this racial group.

Dr. Williams also noted and discusses in great detail in his book - the types of stroke, the treatment, the outcomes and the possibility of diverting a tragic end. We are most familiar with and scared of the type of stroke that occurs from a blocked blood vessel leading to the brain (ischemic stroke). He explained that there were two treatments for that, but he focused on the one he referred to as intravenous TPA. TPA (tissue plasminogen activator) is the medicine and in this case it is administered through a vein. This medication is known as a clot buster and it can restore blood flow - however it must be administered within three hours of the stroke start - the earlier it is used the better the outcome - or as he said, "time is brain" - it is the difference between incapacity, death or going home independently. The medicine cannot be used after the time frame because it can cause serious adverse complications. It also cannot be used with a bleeding stroke.

I really think that you would enjoy hearing the show yourself and also listening to the callers for which he showed great respect and compassion as they explained their own history of stroke or that of their loved ones.

I believe that other treatment options include anticoagulant and antiplatelet medications as well as several types of surgery.