[Primary prevention of coronary heart disease: possibilities and limitations]

Cardiovascular diseases are still the most important cause of death in industrialized countries. In spite of enormous progress regarding prevention, diagnostic and therapeutic procedures, coronary heart disease remains the most important cardiovascular cause for early invalidity, professional inactivity and premature death. The direct and indirect costs of cardiovascular diseases amount to 14.8% of total disease-related costs. The practicing physician has an important role to play in the prevention of cardiovascular diseases. In order for the physician to understand his critical role and to act accordingly, some fundamental epidemiological principles are introduced. Particularly, the notion of population attributable risk is important: As a consequence for the health of whole population groups, it is as important to advise the many at intermediate risk as the few at high risk of a cardiovascular accident. The future challenges are clear. This disease group is to a large extent preventable; efficient intervention models, both on an individual and on a community level, are available.