Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society.

Of the highest priority for preventive medicine in Europe is to achieve a major reduction in coronary heart disease (CHD) and other manifestations of atherosclerosis. To this end a policy based upon reduction of risk factors has been formulated by experts from 19 countries: it employs complementary strategies directed to CHD-prone populations as a whole and to individuals at particular risk. The population strategy includes improved nutrition, avoidance of smoking, blood pressure reduction and promotion of suitable exercise. These should be based upon health education for all age groups and actions by governmental and supranational agencies (including implementation of food labelling, smoking control measures and wide provision of exercise facilities). Only measures directed to the population can reach the large proportion of people at mild to moderate risk of CHD. To provide care for individuals at particular risk of CHD, case finding requires that risk factor assessment, including measurement of plasma cholesterol and blood pressure, be included in full medical examinations. The relative merits of other modes of case finding, including selective screening and general screening, are discussed. Decisions concerning management of elevated lipid levels should be influenced by overall cardiovascular risk, by a family history of CHD and by age. Lipid lowering dietary and drug therapy should take these variables into account in addition to the extent and type of the hyperlipidaemia. Cholesterol levels exceeding about 5.2 mmol l-1 (200 mg dl-1) deserve consideration, and the goal of therapy should be to reduce levels towards this value. For most persons with levels of 5.2-6.5 mmol l-1 (200-250 mg dl-1) dietary advice and correction of other risk factors are appropriate, i.e. management comprises reinforcement of population strategy. Dietary recommendations for the control of hyperlipidaemia are reviewed, and indications for drug therapy are presented. Non-pharmacological methods for reducing mildly elevated blood pressure are discussed, and reduction of CHD risk in diabetes is reviewed. Implementation of these recommendations will be furthered by their endorsement by cardiologists and other physicians.