The current status of primary prevention in coronary heart disease

Abstract

During the second part of the twentieth century, research advances caused a substantial decline in the rate of coronary heart disease. The decline lasted from the mid-1960s until the early 1990s and occurred primarily in Western countries. However, an unfavourable trend in coronary heart disease related mortality has gradually developed during the 1990s, with cardiovascular diseases anticipated to remain the main cause of overall mortality for the foreseeable future. The present paper aims at analyzing the current status of the main determinants of population-wide coronary heart disease prevention.

Figure 1

Relationship between cardiovascular risk factors and cardiovascular diseases. HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Figure 2

Cholesterol distribution and its shift (dashed line) with application of population approach. Data from Carleton et al [95].

Figure 3

Prevalence distribution (bars) of serum cholesterol concentration related to age-adjusted mortality from coronary heart disease (CHD) (broken curve) in men aged 40-59 years. The number above each bar is the percentage of death "attributable" to the cholesterol effect and arising at that level. Data from Martin et al [96].

Figure 4

A conceptual framework for public health practice in cardiovascular disease prevention.

Figure 5

Preventive strategies in CHD. A holistic approach to quantitative assessment.

Figure 6

Coronary risk chart for primary CHD prevention in men. Published with permission from [97].

Figure 7

Coronary risk chart for primary CHD prevention in women. Published with permission from [97].