Volume 1 Guidelines Foreword

FOREWORD

RISK FACTORS AS CAUSES OF CORONARY HEART DISEASE

Several criteria have been used as guidelines in judging whether an epidemiological association reflects a causal role of a particular risk factor. These include the strength of the association and its consistency in different studies and populations. This association should be independent, graded and continuous, the incidence of disease increasing with increasing levels of the risk factor. Prospective studies should establish a causal time sequence, with the factor preceding the disease.

The causal role of a risk factor becomes more plausible if the association is concordant with findings from clinical observations, controlled trials and animal studies, and if credible mechanisms are demonstrated by which the risk factor would be expected to contribute to the pathogenesis of the disease.

By these criteria, plasma cholesterol and blood pressure, cigarette smoking and a diet rich in saturated fat and cholesterol, all fully qualify as causal risk factors for coronary heart disease. They influence risk powerfully, they are common in populations, and are amenable to prevention or treatment. In addition to the above, most authorities today regard low HDL cholesterol as a causal risk factor.

STRATEGIES OF PREVENTION
Current strategies for the prevention of coronary heart disease are based on a wealth of scientific knowledge which is constantly increasing. The integration of new information with the 1987 and 1988 policy statements of the European Atherosclerosis Society has enabled the International Taskforce for the Prevention of Coronary Heart Disease to compile a set of updated and comprehensive recommendations; this Desktop Guide summarises the clinical section of these recommendations.

The content of this Summary is in accord with the 1982 World Health Organisation Expert Committee recommendations for a comprehensive plan for the prevention of coronary heart disease, which includes:

A Population Strategy: Control, in the entire population, of those lifestyle and environmental factors which increase the risk for coronary heart disease.

A High Risk Strategy: Identification of individuals at high risk, and action to reduce their risk factor levels.

Secondary Prevention: Prevention of progression of symptomatic coronary heart disease and its serious complications.

The population strategy is based on the recognition that in populations with high heart disease rates, such as those with ‘westernised’ lifestyles, the majority of individuals are exposed to one or more risk factors for coronary heart disease. This is largely due to:

An inappropriate national diet, inadequate or absent physical activity, and obesity; these risk factors are reflected in increased levels of plasma cholesterol (i.e. LDL cholesterol) and blood pressure in the population.

Widespread cigarette smoking.

THE ROLE OF THE DOCTOR

While physicians have been traditionally trained in individual care (high risk strategy and secondary prevention), their role is also vital to the population approach. As experts and leaders in the medical and health care field, doctors can have a positive influence on policies of health promotion. Through their communication with patients and family members, in addition to a healthy personal example, physicians have a major role to play in increasing public awareness and modifying attitudes and behaviour in matters of health.

European Atherosclerosis Society
International Taskforce for the Prevention of Coronary Heart Disease

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