Perspectives for the primary prevention of coronary heart disease.

A massive body of scientific evidence from clinical, experimental, pathological and epidemiological studies as well as from risk factor intervention trials and community studies has emerged until the 1980s; interpreted as a whole it leaves no more doubt about the major role of hyperlipidaemia, hypertension, cigarette smoking and some other modifiable factors in the aetiology of atherosclerosis and CHD, and about the great potential for primary prevention of CHD. In response to this challenge, the World Health Organization Expert Committee in its report in 1982 outlined the general principles and strategies for the primary prevention of CHD, and these principles and strategies have then been reinforced and further developed toward practical action plans by international and national experts groups. The perspectives for the primary prevention during the future decades may be envisaged to include: (1) further strengthening of preventive action in those countries with high or relatively high CHD rates in which favourable changes in life-styles and risk factor levels are already going on and CHD rates are declining; (2) development and implementation of effective plans for preventive action in those countries with high or relatively high CHD rates in which these rates are not yet declining or even increasing, and (3) development and implementation of effective plans for a real primordial prevention of CHD, i.e., preventing the appearance of unhealthy life-styles and elevated risk factor levels, in those developing countries in which CHD threatens to emerge in connection with socio-cultural changes toward urbanization and industrialization.