Dear Jane,

I read with great interest your recent contribution. It was an interesting point you raised about the ongoing research into genetic factors of CVD. It is well documented that a strong family history is an important risk factor for CVD, but researching and perhaps discovering the genetic component to CVD, as you mentioned, will be a highly expensive exercise. Then, if such technology actually became available to be able to modify one's genetic predisposition to CVD, surely it would only benefit a handful of very wealthy subjects. As you rightly stated, hardly a cost effective exercise and surely unlikely to make an impact on reducing the incidence of CVD worldwide.

In addition, you pointed out that an astounding 95% of people living in developed countries have one or more of the 3 basic risk factors, diet, physical inactivity, smoking, that are well documented causes of CVD. Gene therapy would be unlikely to be successful anyway if these risk factors were not addressed in the first instance. I agree with you that these areas need to be promoted but I would go one step further to say that they need to be indoctrinated into general Public Policy from all sectors so that choosing healthy behaviours becomes the easiest choice for communities as a whole. To use your examples,

Diet: healthy foods such as fresh fruit and vegetables should be widely available to all communities, easily accessible and appreciably cheaper than processed foods.

Physical activity; e.g. sport and non competitive exercise should be an integral component of  every school's curriculum, with the opportunity for all kids of all levels to be involved so as to build skills for involvement throughout life. Town planners ensure there are areas for recreation and sport available for everyone in the community.

Smoking: Public policy which emphasise that it is unhealthy and unfashionable to smoke, such as banning it in public places including bars and restaraunts.

By targeting communities as a whole healthy lifestyle choices become the easy and preferable choice for the individual.

As you also stated CVD is responsible for over a quarter of the world's mortality, the majority of which occur in the poorer regions of the world. Dr Raphael in has recent email also suggested that living conditions such as low income had a greater impact on CVD than traditional risk factors. Perhaps then if the geneticists were able to engineer individuals that were immune to low income and poverty their money would be better spent.
 
Dr Sophie Scamps
Dublin.