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.