Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Patient-centered prevention strategies for cardiovascular disease, cancer and diabetes

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 656–666 (2007)Cite this article

Abstract

Collectively, cardiovascular disease, cancer and diabetes are responsible for more than 25 million deaths in the world each year, and millions more live with one or more of these diseases. Much of this disease burden could be prevented, however, by controlling the modifiable risk factors. Although this Review focuses primarily on health-care providers caring for patients with cardiovascular disease, we stress the importance of considering the totality of patients' health. We discuss the common features and risks of cardiovascular disease, cancer and diabetes, and how best to implement practices aimed at prevention. The shared risk factors of tobacco use, physical inactivity, overweight and obesity, and poor nutrition, and their management are discussed. General risk-factor screening recommendations are also outlined and specific screening strategies for the disease states are given. Finally, we discuss the appropriate role of cardiology health-care providers with respect to risks for other chronic conditions and occult disease.

Key Points

  • This Review discusses the common features and risks factors for cardiovascular disease, cancer and diabetes, and how best to implement practices aimed at prevention

  • In order to reduce the human and economic toll of cardiovascular disease, cancer and diabetes, there must be an increased focus on public-health interventions and increased adherence to clinical practice guidelines to detect and treat these diseases and their risk factors, beginning early in adult life

  • As reducing disease risk does not eliminate the risk of disease entirely, the early detection of chronic conditions through screening programs is vital, and can alter the natural history of the disease through therapeutic interventions that either treat precursor lesions or early-stage disease

  • In cardiology, ongoing surveillance and management of cardiovascular conditions will, naturally, be the primary focus, but it is important to also recognize that many cardiology patients are probably not receiving timely screening for other chronic conditions

  • The value of effective cardiovascular disease management is ultimately lost if the cardiology patient is subsequently diagnosed with a preventable disease that becomes the new dominant risk to overall health

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Risk factors common to cancer, cardiovascular disease and diabetes.
Figure 2: General screening recommendations for adults based on recommendations from the American Cancer Society, the American Diabetes Association and the AHA.

Similar content being viewed by others

References

  1. Rosamond W et al. (2007) American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 115: 69–171

    Article  Google Scholar 

  2. World Health Organization: Cardiovascular disease: prevention and control [http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/]

  3. American Heart Association: International cardiovascular disease statistics [http://www.americanheart.org/presenter.jhtml?identifier=3001008]

  4. World Health Organization (online February 2006) Cancer [http://www.who.int/mediacentre/factsheets/fs297/en/index.html] (accessed May 28 2007)

  5. World Health Organization (2003) The World Health Report 2003. Geneva, World Health Organization

  6. Eyre H et al. (2004) Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, American Diabetes Association and American Heart Association. Circulation 109: 3244–3255

    Article  Google Scholar 

  7. Smith SC Jr et al. (2006) AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 Update. Circulation 113: 2363–2372

    Article  Google Scholar 

  8. US Department of Health and Human Services and US Department of Agriculture. (2005) Dietary Guidelines for Americans, 2005. Washington, DC: US Government Printing Office

  9. Chobanian AV et al. (2003) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42: 1206–1252

    Article  CAS  Google Scholar 

  10. World Health Organization (2005) The tobacco health toll [http://www.emro.who.int/tfi/PDF/TobaccoHealthToll.pdf] (accessed January 3 2007)

  11. Centers for Disease Control and Prevention and National Center for Health Statistics (2002) Annual smoking attributable-mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR Morb Mortal Wkly Rep 51: 300–303

  12. World Health Organization; International Agency for Research on Cancer (2002) Tobacco Smoke and Involuntary Smoking [http://monographs.iarc.fr/ENG/Monographs/vol83/volume83.pdf] (accessed May 26 2007)

  13. Godtfredsen NS et al. (2005) Effect of smoking reduction on lung cancer risk. JAMA 294: 1505–1510

    Article  CAS  Google Scholar 

  14. Muhlhauser I et al. (1996) Cigarette smoking and progression of retinopathy and nephropathy in type 1 diabetes mellitus. Diabetes Med 13: 536–543

    Article  CAS  Google Scholar 

  15. Will JC et al. (2001) Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J Epidemiol 30: 540–546

    Article  CAS  Google Scholar 

  16. Hu FB et al. (2001) Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345: 790–797

    Article  CAS  Google Scholar 

  17. Fiore M (2000) Treating Tobacco Use and Dependence. Rockville, MD: US Department of Health and Human Services, Public Health Service

    Google Scholar 

  18. Katz DA et al. (2004) Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: a randomized, controlled trial. J Natl Cancer Inst 96: 594–603

    Article  Google Scholar 

  19. US Preventive Services Task Force (2004) Guide to Clinical Preventive Services, edn 3. Baltimore: Williams & Wilkins

  20. Rallidis LS et al. (2005) Persistent smokers after myocardial infarction: a group that requires special attention. Int J Cardiol 100: 241–245

    Article  Google Scholar 

  21. Peterson AV Jr et al. (2006) Nine-year prediction of adolescent smoking by number of smoking parents. Addict Behav 31: 788–801

    Article  Google Scholar 

  22. Hossain P et al. (2007) Obesity and diabetes in the developing world—a growing challenge. N Engl J Med 356: 213–215

    Article  CAS  Google Scholar 

  23. Hedley AA et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291: 2847–2850

    Article  CAS  Google Scholar 

  24. Poirier P et al. (2006) Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 113: 898–918

    Article  Google Scholar 

  25. National Institutes of Health; National Heart, Lung, and Blood Institute (Online September 1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report [http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf] (accessed May 26 2007)

  26. The IDF consensus worldwide definition of the metabolic syndrome [http://www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf]

  27. Calle EE et al. (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348: 1625–1638

    Article  Google Scholar 

  28. International Agency for Research on Cancer (2002) IARC handbooks of cancer prevention. Vol 6: Weight control and physical activity. Lyon, France: IARC Press

  29. Mokdad AH et al. (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA 289: 76–79

    Article  Google Scholar 

  30. Field AE et al. (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 161: 1581–1586

    Article  CAS  Google Scholar 

  31. Wilson PWF et al. (2007) Prediction of incident diabetes mellitus in middle-aged adults—the Framingham Offspring Study. Arch Intern Med 167: 1068–1074

    Article  Google Scholar 

  32. Klein S et al. (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care 27: 2067–2073

    Article  Google Scholar 

  33. American Diabetes Association (2007) Standards of medical care in diabetes—2007 (Position statement). Diabetes Care 30 (Suppl 1): S4–S41

  34. Will JC et al. (2002) Intentional weight loss and 13-year diabetes incidence in overweight adults. Am J Public Health 92: 1245–1248

    Article  Google Scholar 

  35. Sigal RJ et al. (2004) Physical activity/exercise and type 2 diabetes. Diabetes Care 27: 2518–2539

    Article  Google Scholar 

  36. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)—final report. Circulation 106: 3143–3421

  37. Sacks FM et al. (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344: 3–10

    Article  CAS  Google Scholar 

  38. Willett WC (1994) Micronutrients and cancer risk. Am J Clin Nutr 59 (Suppl): S1162–S1165

    Article  Google Scholar 

  39. International Agency for Research on Cancer (2003) IARC handbooks of cancer prevention. Vol 8: Fruit and vegetables. Lyon, France: IARC Press

  40. Thompson PD et al. (2003) Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 107: 3109–3116

    Article  Google Scholar 

  41. Varo JJ et al. (2003) Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol 32: 138–146

    Article  Google Scholar 

  42. Breslow RA et al. (2001) Long-term recreational physical activity and breast cancer in the National Health and Nutrition Examination Survey I epidemiologic follow-up study. Cancer Epidemiol Biomarkers Prev 10: 805–808

    CAS  PubMed  Google Scholar 

  43. Slattery ML and Potter JD (2002) Physical activity and colon cancer: confounding or interaction? Med Sci Sports Exerc 34: 913–919

    Article  Google Scholar 

  44. National Cancer Institute (March 29 2004) Physical Activity and Cancer: fact sheet [www.cancer.gov/newscenter/pressreleases/PhysicalActivity] (accessed September 3 2007)

  45. Calle EE and Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4: 579–591

    Article  CAS  Google Scholar 

  46. Calle EE et al. (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348: 1625–1638

    Article  Google Scholar 

  47. Morrato EH et al. (2007) Physical activity in US adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care 30: 203–209

    Article  Google Scholar 

  48. Hing E et al. (2006) National ambulatory medical care survey: 2004 summary. Advance data from vital and health statistics: no 374. Hyattsville, MD: National Center for Health Statistics

  49. Peltenburg M et al. (2004) The unexpected in primary care: a multicenter study on the emergence of unvoiced patient agenda. Ann Fam Med 2: 534–540

    Article  Google Scholar 

  50. Coffield AB et al. (2001) Priorities among recommended clinical preventive services. Am J Prev Med 21: 1–9

    Article  CAS  Google Scholar 

  51. Maciosek MV et al. (2001) Methods for priority setting among clinical preventive services. Am J Prev Med 21: 10–19

    Article  CAS  Google Scholar 

  52. Smith RA and Wender RC (2004) Cancer screening and the periodic health examination. Cancer 100: 1553–1557

    Article  Google Scholar 

  53. Ruffin MT et al. (2000) Predictors of screening for breast, cervical, colorectal, and prostatic cancer among community-based primary care practices. J Am Board Fam Pract 13: 1–10

    Article  CAS  Google Scholar 

  54. Fryer GE Jr et al. (2004) Specialist physicians providing primary care services in Colorado. J Am Board Fam Pract 17: 81–90

    Article  Google Scholar 

  55. US Preventive Services Task Force (USPSTF) [http://www.ahrq.gov/clinic/uspstfix.htm]

  56. Tuomilehto J et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343–1350

    Article  CAS  Google Scholar 

  57. Knowler WC et al. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346: 393–403

    Article  CAS  Google Scholar 

  58. American Diabetes Association (2004) Screening for type 2 diabetes (Position statement). Diabetes Care 27 (Suppl 1): S11–S14

  59. Engelgau MM et al. (2000) Screening for type 2 diabetes. Diabetes Care 23: 1563–1580

    Article  CAS  Google Scholar 

  60. American Diabetes Association (2006) Diagnosis and classification of diabetes mellitus (Position statement). Diabetes Care 29 (Suppl 10): S43–S48

  61. Danaei G et al. (2005) Causes of cancer in the world: comparative risk assessment of nine behavioral and environmental risk factors. Lancet 366: 1784–1793

    Article  Google Scholar 

  62. Smith RA et al. (2003) American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 53: 141–169

    Article  Google Scholar 

  63. American Cancer Society guidelines for the early detection of cancer (online 28 March 2007) [http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_ Detection_Guidelines_36.asp?sitearea=PED] (accessed 9 October 2007)

  64. Pignone M et al. (2002) Screening for colorectal cancer in adults at average risk: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 137: 132–141

    Article  Google Scholar 

  65. Winawer S et al. (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—Update based on new evidence. Gastroenterology 124: 544–560

    Article  Google Scholar 

  66. Smith RA et al. (2001) American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001—testing for early lung cancer detection. CA Cancer J Clin 51: 38–75

    Article  CAS  Google Scholar 

  67. America Cancer Society [www.cancer.org]

  68. American Diabetes Association [www.diabetes.org]

  69. American Heart Association [www.americanheart.org]

Download references

Author information

Authors and Affiliations

  1. KA Taubert is Senior Scientist at the American Heart Association and adjunct Professor of Physiology, University of Texas Southwestern Medical School, Dallas, TX,

    Kathryn A Taubert

  2. NG Clark is National Vice President for Clinical Affairs, American Diabetes Association, Alexandria, VA,

    Nathaniel G Clark

  3. RA Smith is Director of Cancer Screening, American Cancer Society, Atlanta, GA, USA.,

    Robert A Smith

Authors
  1. Kathryn A Taubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathaniel G Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert A Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn A Taubert.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taubert, K., Clark, N. & Smith, R. Patient-centered prevention strategies for cardiovascular disease, cancer and diabetes. Nat Rev Cardiol 4, 656–666 (2007). https://doi.org/10.1038/ncpcardio1029

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1029

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing