Table of Contents

ABSTRACT

Background: The World Health Organization and all other health-related organizations have always emphasized the primordial prevention of cardiovascular diseases (CVDs) and other metabolic diseases. This review focuses on the emergence of cardiovascular diseases and diabetes and the merit of initiating prevention from the preconception stage.
Methods: A systematic and narrative review was conducted to find articles related to CVDs and diabetes, using databases of WHO, Google Scholars, MEDLINE (PubMed), Web of Science, and EBSCO, with additional secondary sources and searching the grey literature. Opinions of experts were also sought and opinions of all authors were obtained as outlined in this document.
Results: The prevalence of lifestyle and behavioral risk factors for most cardiovascular diseases and diabetes is rapidly increasing in low- and middle-income populations due to the ongoing economic development, which is leading to rapid changes in people’s diets and lifestyles. There is a decline in such risk factors in high-income countries due to education and the adoption of preventive strategies, which is resulting in a reduction in cardiovascular disease mortality. After World War II, there were food shortages from 1945 to 1965 in the majority of the developing and newly industrialised countries, with low risk of cardiovascular diseases and diabetes. Hypertension (5-10%), type 2 diabetes (T2DM) (3-5%), and CAD (3-4%) were very low in the adult populations of India, China, Eastern and Central Europe, and in the African sub-continent, all of which had less economic development up to the last decade of the last century. Famine-like conditions in early life and preconception risk factors might have predisposed a thrifty genotype, with increased susceptibility to cardio-metabolic diseases (CMD) in all these countries. It might not be poverty, but the lack of health education and a lack of motivation, possibly due to ineffective policies of national and local governments that are major determinants of the increased risk of these diseases. In urban areas as well as in immigrant populations of India and China, which are economically better off, cardiovascular diseases and type 2 diabetes mellitus are significantly higher than they are in some of the high-income populations. Health education and promotion of healthier lifestyle and behavior, if started from the preconception period, might cause primordial prevention in these countries. A wild-type omega-6/3 diet, in particular along with flavonoids and antioxidants, might blunt epigenetic risk-variances at the individual level across all subgroups, beginning from the preconception period to the elderly.
Conclusion: These findings might require modification of the existing American and European as well as Asian guidelines that are proposed for the prevention of cardiovascular diseases and other metabolic diseases in all populations.

Keywords: Diet, nutrition, hypertension, heart disease, type 2 diabetes, stroke, preconception.