The Legacy Effect in the Prevention of Cardiovascular Disease.

Esther Viñas Esmel,Emilio Sacanella Meseguer,José Naval Álvarez

doi:10.3390/nu12113227

Abstract

The “legacy effect” describes the long-term benefits that may persist for many years after the end of an intervention period, involving different biological processes. The legacy effect in cardiovascular disease (CVD) prevention has been evaluated by a limited number of studies, mostly based on pharmacological interventions, while few manuscripts on dietary interventions have been published. Most of these studies are focused on intensive treatment regimens, whose main goal is to achieve tight control of one or more cardiovascular risk factors. This review aims to summarise the legacy effect-related results obtained in those studies and to determine the existence of this effect in CVD prevention. There is sufficient data to suggest the existence of a legacy effect after intensive intervention on cardiovascular risk factors; however, this effect is not equivalent for all risk factors and could be influenced by patient characteristics, disease duration, and the type of intervention performed. Currently, available evidence suggests that the legacy effect is greater in subjects with moderately-high cardiovascular risk but without CVD, especially in those patients with recent-onset diabetes. However, preventive treatment for CVD should not be discontinued in high-risk subjects, as the level of existing evidence on the legacy effect is low to moderate.

Highlights

Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality, accounting for 30% of all deaths worldwide
We focus on the recent evidence of the legacy effect and metabolic memory in CVD development after intensive pharmacological and non-pharmacological interventions addressing cardiovascular risk factors
The differences observed among the outcomes of the trials and their post-trial follow-up studies have been described by using the difference in means, risk ratio (RR), odds ratio (OR) and hazard ratio (HR) measures

Summary

Introduction

Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality, accounting for 30% of all deaths worldwide. The intensive management of cardiovascular risk factors is required to reduce its incidence, and some authors suggest that achieving tight control at early stages of the disease, before vascular damage has developed, is a determinant of outcomes [1]. The legacy effect concept refers to long-term sustained benefits after a period of intensive treatment intervention, even after cessation of the intervention [2]. The concept of metabolic memory, mostly described in the study of diabetic models, refers to DNA’s ability to store information related to prior poor metabolic control; for example, persistent adverse effects of hyperglycaemia may reduce the potential benefit of subsequent improvements in glucose control, and induce the development of vascular complications in target organs [4,5]. Achieving good glycaemic control in the early stages of diabetes could be critical in preventing late-stage complications [6,7]

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