Risk factor control in coronary heart disease. Who needs it?

Most patients seen in the offices of primary care physicians in the United States have habits that put them at needlessly high risk of coronary heart disease. These patients usually report that they would like help from their physician in changing their habits. Peer group pressure, however, tends to discourage change. In comparison with making large changes in selected individuals, making small changes in the expectations and behaviors of an entire peer group is easier and will lead to greater changes in disease rates. All patients seen by a physician should have a periodic nutritional assessment, smoking assessment, and blood pressure measurement. Those patients who do not smoke, are normotensive, and have optimal dietary patterns should be vigorously praised. Those who have less than optimal risk factor behaviors should receive further intervention.