Catching up the Europeans in preventing heart disease.

Catching up the Europeans in preventing heart disease Mortality from cardiovascular disease in the United Kingdom compares poorly with other countries in Western Europe; Northern Ireland and Scotland have particularly high rates.' The results of the prospective phase of the British Regional Heart Study provide an opportunity to review current knowledge of cardiovascular risk factors based on data from middle aged (40-59) men in 24 towns.2 The results have confirmed the importance of cigarette smoking, raised blood pressure, and raised serum cholesterol concentrations as risk factors for ischaemic heart disease (acute myocardial infarction or sudden death). Obesity was a risk factor when considered alone but seemed to exert its effect through its influence on blood pressure and cholesterol. Cigarette smoking trebled the risk above the rates in men who had never smoked. Raised systolic blood pressure doubled the risk when it was more than 148 mm Hg (the top 40% of men). The risk was also doubled in the top fifth of the body mass index relative to the lowest fifth-a difference in weight of around 20 kg. A continuous and substantial increase in risk was observed with increasing serum cholesterol concentrations. Men in the top fifth had a threefold increase in risk compared with those in the bottom fifth of the range of serum cholesterol values. A raised cholesterol concentration seemed to be a risk factor for subsequent ischaemic heart disease in those with pre-existing ischaemic heart disease at entry. Data of this kind show the importance of prevention, and the responsibility for this task falls mainly on those providing primary health care. General practitioners have regular contact with most of their patients, and their practice list comprises a relatively well defined population.3 The first priority must be to stop smoking. The contribution of the general practitioner to persuading patients to stop smoking has been shown to give success rates of 5-10%. These figures may be well below those hoped for in therapeutic interventions but if all general practitioners made the effort they would have an impact.4 Next, the treatment of asymptomatic hypertension is mainly justified by the reduction it produces in the incidence of stroke, but the recent Medical Research Council mild hypertension treatment trial suggested another possible gain-a reduction in coronary events among non-smoking patients with hypertension treated with propranolol5; a similar observation was noted for men in the International Prospective Primary Prevention Study in Hypertension trial.6 …