[Prevention of classical risk factors. A public health and health policy task]

Epidemiologic cohort studies such as Framingham, Tecumseh, Evans County and the Multiple Risk Factor Intervention Trial Cohort Study have shown, that hypercholesterolemia, hypertension and cigarette smoking are the strongest predictors for cardiovascular diseases and especially for coronary heart disease. From the intervention studies of the last two decades it has been learn that reductions of the risk factors hypercholesterolemia and hypertension have led to the predicted reductions in cardiovascular and all cause mortality. Two strategies are available for the prevention of hypercholesterolemia and hypertension: The population strategy and the high risk strategy. With regard to cholesterol and blood pressure the population approach strives for the shifting of the respective population distributions to the left i.e. to lower values. The high risk strategy on the other hand restricts itself to the 10-20% of the population with very high values. A comparison of the population and high risk strategy shows, that only the population strategy is radical in that only this strategy is capable to eliminate the causes of the incidence of hypercholesterolemia and hypertension. The high risk strategy on the other hand is unable to influence the total distribution curve. Population strategy and high risk strategy should be seen as complementary. To further reduce mortality and morbidity from cardiovascular diseases in the Federal Republic of Germany the following public health programs and health policy strategies must be applied: a) Reinforcement of the National High Blood Pressure Education Program. b) Establishment of a National High Cholesterol Education Program. c) Nationwide Anti-smoking Campaigns and Programs.(ABSTRACT TRUNCATED AT 250 WORDS)