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  1. Addressing predisease conditions (clinical triggers for chronic disease): A pathway for primary prevention of disease.

    Alok Gupta, Pennington Biomedical Research Center, Louisiana State University System

    9 March 2013

    Birth is usually followed by natural death. A disease can often hasten death. Predisease conditions, covertly present decades earlier [1], have been thought to promote early death, by insidiously converting into overt disease over time. It is, however, also being recognized that predisease conditions like prediabetes and prehypertension, do not only have a high prevalence among healthy adults in the United States [2,3], but also place these healthy individuals on an accelerated pathway for cardiovascular adverse events [4]. This risk appears to begin with an enlargement of the waist circumference, deposition adipose tissue in ectopic locations (visceral, liver and muscle), and adipose tissue dysfunction leading to worsening insulin resistance and/or systemic inflammation [5,6]. The early functional consequences of these changes,upon the cardiovascular system, can be elucidated with non-invasive assessment of circadian blood pressure variability and resting endothelial function [7]. While altered variability of blood pressure increases the risk for stroke, endothelial dysfunction places one at risk for a heart attack. Assessing functional measures (circadian blood pressure variability and resting endothelial function) along with adipose tissue dysfunction (systemic inflammation and insulin resistance) in at risk, but otherwise healthy individuals, can provide avenues for primary prevention of disease [6]. These assessments can let us get beyond the lifestyle measures (diet, increase in exercise to sustain weight loss) currently reserved for intervention with predisease conditions. Abnormal circadian blood pressure variability could be reset with bromocriptine, increased systemic inflammation could be treated with salicylates and insulin resistance could be reversed with a biguanide (metformin) or thiazolidinedione (pioglitazone).
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    Gupta AK, et al. 2Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome. Elsevier Inc.: Academic Press; 2012. p. 57¿75. 3Hypertens Res. 2010; 33(9):905-10. 4Hypertens Res. 2011; 34(4):456-61. 5J Inflamm (Lond). 2010; 7:36. Highly accessed. 6Cardiovasc Diabetol. 2013 Jan 24; 12(1):23. 7Cardiovasc Diabetol. 2010; 9:58. Highly accessed.
    8WHO: Noncommunicable diseases. Fact sheet. September 2011.

    Competing interests