Community intervention to control plasma lipids

A necessary part of the strategy of modification of hypercholesterolaemia to prevent coronary heart disease (CHD) is the detection and treatment, by diet or by drugs, of high risk individuals. There are several drawbacks to this approach: (1) the cost of screening to find individuals at risk and of monitoring by physicians of their therapy; (ii) the problem of labelling asymptomatic people as 'sick' and advising them on special diets; (iii) difficulties in compliance. If the community norm is to eat a diet high in fat, it is difficult for individuals to change, both because it marks them as 'odd' within the culture and because foods low in saturated fat may be difficult to obtain and are expensive. A further limitation is that only those individuals at highest risk may benefit. In a country with a high rate of CHD the problem is that the mean is high. The aim therefore should be to reduce the population mean and shift the whole distribution to the left. This suggests a policy of health education and of policies that remove the barriers against choosing a healthy diet. Even were such policies to be implemented successfully these alone would not abolish social and regional differences in CHD mortality.