Mandeep Mehra, MD: Primordial Care and Behavior in Heart Failure

Mandeep Mehra, MD: I think a lot about the concept of thinking about the primordial care of patients. What is primordial care? Primordial care is actually doing things that don't allow risk factors to be generated. So it's even before risk markers become manifested. Our ability to think through cardiovascular disease starts at the inception point of detection of risk markers - like tobacco smoke, obesity, hypertension, cholesterol, and things like that - and what we're saying is that we need to actually be even more proximate than that, to primordial care.

Primordial care, by definition, is something that has to be a culture shift. Primordial care has to be a social shift. Primordial care is something that is started at home, from birth. Primordial care is started in schools. This is not something where you have to wait for a risk to develop. Right now, a person with high blood sugar will come to a physician, but we're saying that with primordial care, you don't need a physician. Primordial care is in your hands. It's in the society's hands, and it's in the government's hands. The government should be creating urban, architectural landscapes to facilitate more walking, for instance, easier bicycling, for instance. You can see places where the weather [is nice] and the government have thought of these opportunities better. Like, say, California, where they tend to have lower obesity rates. So there are already examples of tackling the emergence of risk factors early on.

Diet is a curious issue. Diet is tough because we're all gravitating toward cheaper and easily accessible foods, and combining those requires a lot of engineering. In that engineering, the quality of the food that is provided to people is often reduced. So moving towards more raw foods, fewer preservatives, more fruits and vegetables (but not an excess), is going to become key as we think through lifestyle modification and behavioral changes in these patients.