Prevention of coronary heart disease: putting theory into practice

The two main approaches to delivering preventive care for coronary heart disease, ie to reducing its causal risk factors, depend upon an understanding of the major causes of this disorder. One is population based and involves educating the public in healthier behaviour and making changes in the environment to facilitate this. In the other, persons at high risk are identified and provided with individual counselling and ongoing care; the diagnostic and therapeutic components of this approach must proceed in parallel, and resources will be needed to permit this. Both strategies are necessary: they are complementary; they are not competitive either conceptually or for funding. Personal risk varies widely. Hence a system of priorities is required for phasing the provision of care according to need. High risk is mot often due to the presence of multiple risk factors but also results from single, pronounced risk factors. Those in greater need include persons with coronary disease, those with multiple sources of risk, and those with severe hypercholesterolaemia, hypertension, or diabetes. So-called selective testing differs little, in practice, from such a prioritized system of comprehensive risk factor control.