Do Risk Factors Change in Men at High Risk of Coronary Heart Disease? Observations on the Effect of Health Promotion in Primary Care

Abstract

There has been an increasing focus on the identification and modification of risk factors for coronary heart disease (CHD) in primary care. One approach is to concentrate activity on those at high risk of CHD. This study was a prospective follow-up after CHD risk assessment and intervention designed to determine whether middle-aged men identified as being at high risk of CHD in primary care, who participated in a randomized controlled trial of antithrombotic medication, reduced their risk factor profile in response to the health promotion given in all practices, whatever their treatment allocation. We studied 4316 men aged 45-69 years (who had not suffered a previous myocardial infarction or stroke) identified at screening in 81 general practices in the UK as being at high risk of coronary heart disease. The changes in the prevalence of smoking and in blood pressure, serum cholesterol level, body mass index and plasma fibrinogen level were recorded for a period of up to 2 years after entry into the trial. The use of standard health education materials and of more intensive individual interventions was substantial. There were regular opportunities through nurses and consultations with general practitioners for continuing advice about risk factors. The prevalence of current smoking fell during the trial but it was still 37% at 2 years. There was a significant decrease in blood pressure due first to regression to the mean but then to the trial's treatment protocol and accommodation to measurement. There were small falls between screening and entry in body mass and levels of serum cholesterol and fibrinogen, again due largely to regression to the mean; subsequent changes in these characteristics were negligible. Sustained and quite intensive health promotion activity had only a limited effect in men identified as being at high risk of CHD. In particular, there was little change in body mass or serum cholesterol. Although improved blood pressure control and a moderate reduction in the prevalence of smoking can be achieved, further research is needed to determine the most effective methods of risk factor reduction in order to realize the full potential of the 'high-risk' approach to the prevention of CHD.