Primary prevention in cardiovascular disease: moving out of the shadows of the truth about death

AIM: This review identifies deficits in current educational efforts for the primary prevention of cardiovascular disease. DATA SYNTHESIS: Essential fatty acids in the foods we eat have a subtle but powerful influence on hundreds of different processes in the life and death of humans, understanding of which has been delayed by two attitudes in the biomedical community. One involves a bias towards expensive curative/treatment interventions that neglect prevention of initial nutritional causes of disease and death, and the other involves careless logic in interpreting evidence of causes of disease and death. Both attitudes interfere with translation of published science of essential fatty acids into effective prevention of cardiovascular deaths, a situation made worse by a widespread wish for simple descriptions of complex interactions in disease. Some clinical signs and risk factors may be only shadows of true causal factors. For example, attention to cholesterol ignored important evidence that nutritional imbalances in expenditure/intake of energy and in omega-3/omega-6 essential fatty acids cause cardiovascular disease. Balancing the few percentage of daily calories in omega-3/omega-6 nutrients is not a question of obesity or blood cholesterol. Effective prevention through education will require targeting the causal risk factors that are known beyond the shadow of a doubt, but seldom discussed by health professionals and the public. CONCLUSIONS: Death from coronary heart disease comes from acute ischemia and arrhythmia, often following long-term chronic inflammatory vascular damage that predisposes to acute fatal thrombosis and arrhythmia. The three processes involve excessive self-healing actions of natural n-6 autacoids (auto = self, akos = healing) produced from tissue essential fatty acids that come only from foods. Readily corrected nutritional imbalances in expenditure/intake of energy and in omega-3/omega-6 essential fatty acids are causal risk factors with plausible mechanisms contributing to fatal events which can be prevented.