Risk factor reduction should be a central component of all coronary heart disease ( CHD ) policies, say the authors. In the UK and the US, current government policy favours risk factor reduction in CHD patients ( known as secondary prevention ), but risk factor reduction across the whole population ( primary prevention ) might be more powerful.
To test their theory, they used a model to synthesise data for the adult population of England and Wales, describing numbers of CHD patients, uptake of treatments, and the effect of reducing three major risk factors ( smoking, cholesterol, and blood pressure ) in people with and without CHD.
Between 1981 and 2000, CHD death rates fell by 54%, resulting in 68,230 fewer deaths in 2000.
Approximately half of this fall ( 45,370 fewer deaths ) was attributable to reductions in smoking, cholesterol, and blood pressure in the whole population. However, primary prevention had a fourfold bigger impact on mortality than secondary prevention, with 81% ( 36,625 ) fewer deaths in people without recognised CHD and 19% ( 8,745 ) fewer deaths in CHD patients.
Primary prevention clearly achieved a larger reduction in deaths, compared with secondary prevention, say the authors. Comprehensive CHD strategies should therefore focus on population-wide tobacco control and healthier diets, they conclude.