Current status of coronary prevention: Lessons from the Framingham study

Abstract

In the past decade dramatic innovations have been made in the management of the acute coronary attack culminating in organized coronary care units and cardiac surgery. Epidemiologic studies have identified major host and environmental contributors to coronary incidence allowing both assessment of risk and identification of vulnerable persons for prophylaxis. Notwithstanding these advances there is no evidence that coronary mortality in the community has been significantly reduced. The authors believe that the only hope for a major impact on coronary mortality lies in primary prevention. Two approaches to the prevention and control of the atherosclerotic diseases are possible. First, by the development of public health measures which will favorably change environmental and host factors. Such measures would include improved regimens of both diet and exercise, elimination of cigarette smoking, and reduction of weight and blood pressure. This will entail a comprehensive and forceful program of education for the American public. It is unlikely that the public will accept the necessary controls of the entire population unless the beneficial effects thereof have been clearly demonstrated on an individual basis. Secondly, by the detection of persons at high risk of developing disease combined with an attempt on an individual basis to change the major adverse host and environmental characteristics. This will require a great deal of effort and motivation by both patient and physician. The degree of change needed and the age at which such change is undertaken are important considerations. The earlier in life positive changes in life habits are instituted, the greater will be the probability of increased longevity and a healthy active life.