Climate change and preventive medicine.

Thermal stress, food poisoning, infectious diseases, malnutrition, psychiatric illness as well as injury and death from floods, storms and fire are all likely to become more common as the earth warms and the climate becomes more variable. In contrast, obesity, type II diabetes and coronary artery disease do not result from climate change, but they do share causes with climate change. Burning fossil fuels, for example, is the major source of greenhouse gases, but it also makes pervasive physical inactivity possible. Similarly, modern agriculture's enormous production of livestock contributes substantially to greenhouse gas emissions, and it is the source of many of our most energy-rich foods. Physicians and societies of medical professionals have a particular responsibility, therefore, to contribute to the public discourse about climate change and what to do about it.     

Diet as preventive medicine in cardiology

Because the main cause of death in patients with established coronary heart disease (CHD) is sudden cardiac death (SCD), physicians should develop specific strategy, including dietary changes, to prevent it. In the long term, reduction of the diet-dependent chronic risk factors of CHD, hypercholesterolemia, hypertension, and diabetes, is also important. The association of the cardioprotective effects of the Mediterranean diet (through various mechanisms, likely including the prevention of SCD) with those expected from the reduction of blood lipids and blood pressure and a better control of diabetes (in addition to its gastronomic appeal) renders this dietary pattern extremely attractive for public health purposes. Experimental and epidemiologic studies, as well as randomized trials, clearly demonstrated that n-3 fatty acids reduce the risk of SCD in CHD patients. Their use is now encouraged either as supplements or as part of a Mediterranean-type diet.     

Electron beam computed tomographic scanning in preventive medicine

Undetected coronary atherosclerosis is present in the majority of patients suffering myocardial infarction or sudden death. Electron beam computed tomography affords noninvasive scanning of the heart to detect and measure coronary calcification. These data permit dramatically improved assessment of both short-term and future risk for cardiac and other events. Knowledge of this risk gives the physician an opportunity for timely and cost-effective interventions.