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The Legacy Effect in the Prevention of Cardiovascular Disease
Esther Viñas Esmel1, José Naval Álvarez1, Emilio Sacanella Meseguer1,2
1Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
Insights
The cardiovascular disease (CVD) legacy effect shows long-term benefits after intensive risk factor treatment. This effect varies by risk factor, patient, and intervention, being more pronounced in those with moderately high risk and recent diabetes.
Area of Science:
- Cardiology
- Preventive Medicine
- Metabolic Disorders
Background:
- The legacy effect, or long-term benefits post-intervention, is recognized in various biological processes.
- Limited research exists on the legacy effect in cardiovascular disease (CVD) prevention, particularly concerning dietary interventions.
- Most studies focus on intensive pharmacological interventions targeting cardiovascular risk factors.
Purpose of the Study:
- To review and synthesize findings on the legacy effect in CVD prevention.
- To assess the existence and characteristics of the legacy effect in cardiovascular health.
- To identify factors influencing the legacy effect in different patient populations.
Main Methods:
- Systematic review of existing literature on cardiovascular disease prevention interventions.
- Analysis of studies reporting long-term outcomes after the cessation of intensive treatment regimens.
- Evaluation of data regarding the impact of patient characteristics and intervention types on the legacy effect.
Main Results:
- Sufficient evidence supports a legacy effect following intensive intervention on cardiovascular risk factors.
- The legacy effect is not uniform across all risk factors and is influenced by patient specifics, disease duration, and intervention type.
- The effect appears greater in individuals with moderately high cardiovascular risk but no established CVD, especially those with recent-onset diabetes.
Conclusions:
- A discernible legacy effect exists in cardiovascular risk factor management, though its magnitude varies.
- The legacy effect is more pronounced in specific subgroups, such as patients with recent-onset diabetes and moderately high cardiovascular risk.
- Discontinuation of preventive CVD treatment is not advised in high-risk individuals due to limited evidence on the legacy effect's reliability in this group.
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.
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