Multiple risk factor intervention in coronary heart disease.

Intervention studies have shown that the primary prevention of coronary heart disease (CHD), or at least its postponement, is possible in a large proportion of individuals. In the Diet-Antismoking Trial of the Oslo Study, it was concluded that in healthy middle-aged men at high risk of CHD (serum cholesterol, 7.5-9.8 mmol/l, and 80% were smokers), the incidence of myocardial infarction and sudden coronary death was reduced by 47% in the intervention group compared to the controls. This study did not have the power to single out the separate effect of cessation of smoking on the incidence of CHD. A significant positive effect of antihypertensive treatment on cerebrovascular events has been shown in many studies, but unfortunately no significant preventive effect on the first event of CHD has been demonstrated. In the Oslo Study a significant positive correlation was found between total serum cholesterol concentration and blood pressure. It is suggested that both risk factors might be treatable or preventable to some extent by the same measures. In health education, both the population mass strategy for prevention and the high risk strategy for individual intervention are important. The frequent coexistence of two or more risk factors should be kept in mind. For CHD prevention, non-pharmacological intervention seems at the moment to be the safest and very often probably the most effective approach.