Fetal roots of cardiac disease

In western countries, cardiovascular disease is the leading killer of men and women. In the past decade, it has become increasingly clear that women are just as vulnerable to heart disease as men. In 2004, the number of women with some form of the disease will exceed the number of such men in the USA (www.americanheart.org). While new medical treatments are prolonging the lives of people with cardiovascular disease, an increasing number of men and women are living with cardiovascular limitations or outright heart failure. The total estimated cost of cardiovascular disease in the USA will exceed $300 billion in 2004. In the coming decades, the disease burden that is directly attributable to cardiovascular disease is expected to increase dramatically in developing countries.

RISK FACTORS

The American Heart Association (AHA) has identified risk factors that were derived from statistical associations with the incidence of coronary disease (www.americanheart.org). Some factors not under the control of an individual include age, hereditary factors, and diabetes mellitus. Other risk factors are influenced by lifestyle choices and include smoking tobacco, sedentary lifestyle, hypertension, and blood lipid profile. These risk factors have been enormously valuable in emphasising prevention as a way to reduce the morbidity and mortality of coronary atherosclerosis. Nevertheless, many cases of heart disease remain unexplained. Every cardiologist sees cases of coronary artery disease in patients with none of the AHA risk factors, and it is well known that many individuals who have multiple risk factors never get disease. Thus, it is not known why some individuals are much more vulnerable for cardiovascular diseases than others. While this uncertainty is usually attributed to differences in genetic background, recent population studies shed new light on …