Population and individual strategies for the prevention of coronary heart disease. Policy of the European Atherosclerosis Society.

Abstract

Coronary heart disease (CHD) risk factors affect a large proportion of European adult populations; hence most CHD results from the exposure of many people to moderately elevated risk factor levels. The population strategy is directed to improving the health-related behaviour of the entire population, by means of mass education and administrative measures aimed at nutrition, smoking and exercise; these measures are reviewed in some detail. This approach is inadequate for minimising risk in the minority in whom pronounced risk factor levels are present (e.g. major forms of hyperlipidaemia); such persons require individual therapy in a clinical setting, i.e. an individual strategy. The European Atherosclerosis Society (EAS) endorses both strategies and regards them as complementary. It advocates a case-finding approach to identifying those people requiring individual care. Although lipid risk factors, like blood pressure, are continuous variables, the EAS has defined action limits for plasma cholesterol, triglyceride and HDL-cholesterol concentrations; the interpretation of these is influenced by the presence and extent of other risk factors and of cardiovascular disease, and by age and sex. Recently the EAS has produced guidelines on the recognition and treatment of hyperlipidaemia. These provide sufficient step by step detail to permit the effective, safe management of most hyperlipidaemic patients by the non-specialised physician, with advice on dietary and drug therapies, and the investigation and management of all major forms of hyperlipidaemia. The main features of these guidelines are described in this paper.