The Legacy Effect in the Prevention of Cardiovascular Disease

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.

Keywords: cardiovascular disease; diabetes; diet; dyslipidaemia; hypertension; legacy effect; metabolic memory.

Figure 1

Pathophysiological mechanisms of metabolic memory in chronic hyperglycaemic conditions. Abbreviations: AGE: advanced glycation end-products; DAG-PKC: diacylglycerol-protein kinase C; GAPDH: glyceraldehyde 3-phosphate dehydrogenase; HbA1c: glycated haemoglobin; miRNA: micro RNA; NF-κB: nuclear factor κB; RAGE: AGE receptor; ROS: reactive oxygen species.