Barriers to lifestyle change, and the need to develop an integrated approach to prevention

Many barriers exist to the delivery of preventive services by both cardiologists and other physicians. These barriers can be overcome by appropriate training and the development of supportive infrastructures. In addition, institutional priorities must change in a direction that encourages such efforts. Cardiologists must recognize the importance of risk-factor modification, and training programs in cardiology should teach appropriate counseling techniques, the use of risk factor-lowering pharmacologic agents, and the manner in which cardiologists should interface with dietitians and other ancillary personnel. In addition, we need to recognize and teach, both by didactics and by example, that counseling patients and carrying out long-term preventive interventions can be as gratifying and interesting as performing dramatic procedures that although valuable and rewarding take place at a very late point in the patient's clinical course and perhaps could have been averted by greater attention to risk-factor modification. Increasingly, the public and governmental agencies are becoming involved in encouraging these endeavors, and cardiologists should be in the vanguard of such efforts, not reluctantly bringing up the rear.