General practice p 1522

We know that coronary heart disease is the commonest cause of avoidable mortality in Britain and Ireland, that Britain's position in the league table of developed nations is poor, and that we should do better in trying to prevent it.1 How to achieve this goal remains an unresolved issue.

In the early 1990s the NHS introduced routine health checks for the over 75s and health promotion clinics for primary prevention in general practice. However, the evidence base for this approach was disappointing. 2 3 More recently priority has been given to reducing risk in patients with established coronary heart disease: as the absolute risk for this group is greater, so is the potential for effective intervention. Much evidence exists that a variety of behavioural changes and drug treatments can reduce morbidity and mortality for those with existing coronary heart disease.4 Stopping smoking; eating a “Mediterranean diet”; participating in exercise; and taking appropriate drug treatment with aspirin, β blockers, angiotensin converting enzyme inhibitors, and …