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UK heart disease prevention project: incidence and mortality results
Insights
This study on coronary heart disease (CHD) prevention found that lifestyle advice moderately reduced smoking but had little sustained impact on risk factors or hard CHD events. Symptom reporting improved, but without objective evidence.
Area of Science:
- Cardiovascular Disease Prevention
- Public Health Interventions
- Epidemiology
Background:
- Coronary Heart Disease (CHD) remains a significant public health concern.
- Multifactorial prevention strategies aim to reduce CHD incidence and mortality.
- Previous trials suggest lifestyle interventions can impact CHD outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a multifactorial prevention program for Coronary Heart Disease (CHD) in a UK population.
- To assess the impact of lifestyle advice on risk factors and CHD endpoints.
- To identify challenges in health advice adherence within an occupational setting.
Main Methods:
- A randomized controlled trial involving 18,210 men aged 40-59 across 24 factories.
- Intervention included advice on diet, smoking cessation, weight control, exercise, and hypertension management.
- Trial duration was 5-6 years with data collected via self-report and medical assessments.
Main Results:
- Self-reported smoking showed moderate reduction; other risk factor changes were small and not sustained.
- No significant effect observed on hard CHD endpoints (myocardial infarction, coronary deaths) or all-cause mortality.
- A 36% reduction in reported angina and chest pain symptoms in the intervention group, not supported by electrocardiographic evidence.
Conclusions:
- The UK intervention showed limited success in modifying risk factors and hard CHD endpoints.
- Apparent symptom reduction may be influenced by reporting bias rather than physiological changes.
- Enhancing the acceptance and adherence to health advice is crucial for effective CHD prevention in the UK.
Abstract:
Results are presented for the UK centre of the WHO European Collaborative Trial in the Multifactorial Prevention of Coronary Heart Disease (CHD). 18 210 men took part, aged 40 to 59; they were employed in 24 factories, which formed the allocation units for a randomised controlled trial lasting 5-6 years. Intervention comprised advice on cholesterol-lowering diet, smoking cessation, weight control, exercise, and treatment of hypertension. Advice was given mainly through factory medical departments, the staff being supplemented a little by a visiting central team. Self-reported cigarette smoking was moderately reduced, but changes in other risk factors were small and not well sustained. There was no clear effect on hard CHD end-points (coronary deaths and myocardial infarction) or on all-causes mortality. However, there was a 36% reduction in the rate at which intervention subjects reported ill with other CHD (principally angina) during the study, and at the end fewer intervention men gave positive responses to a self-administered questionnaire on angina and chest pain. These apparent benefits were not substantiated by electrocardiographic evidence, suggesting that participation in a heart disease prevention campaign may bias reporting of symptoms. Experience in other centres of the Collaborative Trial, however, suggests that more effective risk factor control does reduce CHD incidence and mortality. This implies that for the UK the problem is to find means of enhancing the acceptance of health advice.