[Barriers to cardiovascular prevention]

Data from observational and clinical trials provide a solid basis for the formulation of recommendations for the prevention of coronary artery disease. Numerous obstacles to the implementation of risk reduction interventions have been identified. These include: the patients, physician and health care organization, financial and social barriers, current government social and health policies, and direct and indirect costs. The strategies to overcome these barriers include the development of predictable clinical guidelines for the management of risk factors, the requirement of expertise in risk factor management in training and certification, the implementation of model programs for risk factor management that have been shown to be effective including those utilizing non physician professionals, the inclusion of risk factor management as a key indicator of the level of care in quality assistance programs and the cost-effectiveness of preventive interventions, physician and nursing education programs, referral clinics with subspeciality services, quality programs and standards, legislation and regulation, implementation of patient compliance. In conclusion, the improvement of risk factor management will require an efficient health care system and a coordinated effort by primary care physicians, other professionals (such as cardiovascular physicians and specialized nurses) and government policy.