Prevention of coronary heart disease and hypertension

This review will concentrate on more recent evidence on the prevention of coronary heart disease and hypertension. With the evidence from lipid-lowering regimes using cholestyramine or gemfibrozil, it is clear that cardiovascular mortality can be reduced by relatively short interventions (years rather than decades). This is surprising in a disease with a long incubation period. We are also on the threshold of much more powerful intervention with the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Follow-up of the very large number of subjects screened for the Multiple Risk Factor Intervention Trial study showed that the relation between serum cholesterol and risk is linear, with no hint of a "safe" level or threshold. This is borne out with the data from rural Chinese, who show the same trend, albeit at levels of risk that are 4% of those of Western populations. The suggestion that low cholesterol levels increase cancer risk appears to result from an artifact. The best dietary interventions for cholesterol lowering are still unresolved, with recent interest in fish oil and olive oil. On the background of raised cholesterol (most Western levels could be regarded as biologically abnormal), cigarette smoking assumes very great importance. Recent evidence from the U.S. Nurses survey points out a two- or threefold increase in risk from as few as four cigarettes per day. With other risk factors the relative risk increases 20-fold. These data are particularly important given that young girls in the United Kingdom and United States currently smoke more than boys.(ABSTRACT TRUNCATED AT 250 WORDS)