Clinical implications of population-based studies in Europe

The cross-fertilization of epidemiology and clinical medicine is a continuous process. The impressive progress in cardiovascular disease (CVD) epidemiology of the last 30 years was substantially reinforced by large population-based intervention studies in the last decade. As a result, guidelines for prevention are emerging with relatively clear implications for clinical medicine in general. Two such guidelines were recently published by the Royal College of General Practitioners (2, 5). However, the application of these general principles in day-to-day doctor-patient interaction is not easy. General health promotion counseling in the family, conscientious case findings, and regular follow-up are the main points of agreement between epidemiologists and progressive clinicians. Preventive treatment with drugs, however, needs to be decided in each case individually. The ever-increasing new epidemiological knowledge, the intimate knowledge of the individual and his family, and the careful balancing of potential benefits and possible side effects of treatment coupled with the art of the clinician are helping physicians to make these difficult decisions correctly. In order to maximally diminish the current need for such difficult decision making, when the patient's risk is already high, generally adopted, sound, and safe health promotion efforts should be pursued by clinicians in their everyday activities. WHO will continue to encourage the accumulation of sound knowledge in prevention of CVD and other chronic diseases. The future calls for comprehensive health promotion policies focused on the individual and on the community, not only in regard to single diseases.