Epidemiological basis for the prevention of coronary heart disease.

Epidemiological studies have laid the basis for a preventive approach to coronary heart disease (CHD). On balance, present evidence indicates that the following should form the basis of a preventive programme: low-fat diet, cessation of smoking, and control of blood pressure. Other factors likely to produce a beneficial effect on CHD occurrence include reduction of obesity and increased physical activity. Although psychosocial factors are most likely to be causally related to CHD, it is not possible at present to provide clear guidelines as to their role in a preventive programme.TRIALS ARE BEING CONDUCTED TO INVESTIGATE THE POSSIBILITY OF PREVENTING CHD BY A VARIETY OF APPROACHES: a doctor-centred approach or health education in certain sectors of a community or in whole communities. These trials have shown that it is possible to achieve behavioural changes and a reduction in the levels of risk factors in a proportion of the participants. It is not yet clear to what extent these changes in levels of risk factors in middle-aged people will lead to a reduction in the incidence of CHD. It can be calculated, however, that the greatest benefit is likely to come from approaches to prevention that involve the whole community, rather than only high-risk groups.