UK heart disease prevention project: incidence and mortality results

Abstract

Results are presented for the UK centre of the WHO European Collaborative Trial in the Multifactorial Prevention of Coronary Heart Disease (CHD). 18 210 men took part, aged 40 to 59; they were employed in 24 factories, which formed the allocation units for a randomised controlled trial lasting 5-6 years. Intervention comprised advice on cholesterol-lowering diet, smoking cessation, weight control, exercise, and treatment of hypertension. Advice was given mainly through factory medical departments, the staff being supplemented a little by a visiting central team. Self-reported cigarette smoking was moderately reduced, but changes in other risk factors were small and not well sustained. There was no clear effect on hard CHD end-points (coronary deaths and myocardial infarction) or on all-causes mortality. However, there was a 36% reduction in the rate at which intervention subjects reported ill with other CHD (principally angina) during the study, and at the end fewer intervention men gave positive responses to a self-administered questionnaire on angina and chest pain. These apparent benefits were not substantiated by electrocardiographic evidence, suggesting that participation in a heart disease prevention campaign may bias reporting of symptoms. Experience in other centres of the Collaborative Trial, however, suggests that more effective risk factor control does reduce CHD incidence and mortality. This implies that for the UK the problem is to find means of enhancing the acceptance of health advice.