International Task Force for Prevention of Coronary Heart Disease

International Task Force for Prevention of
Coronary Heart Disease

CORONARY HEART DISEASE: REDUCING THE RISK

In recent years, there have been important advances in our understanding of cardiovascular disease prevention. Several well conducted controlled trials and meta-analyses of trials have been reported in the past five years, including trials of the powerful statin drugs. The safety of cholesterol-lowering treatment has become increasingly well established. Also, further coronary heart disease risk factors have been recognised. The International Task Force for Prevention of Coronary Heart Disease has developed this document to take into account these new achievements. Since the choice of treatment for risk factors, and the goal of treatment, depend on the individual's global risk of coronary heart disease (CHD), a simple approach to risk assessment is provided. This takes both classical and newly-identified risk factors into account.

Figure 1: Time trends in mortality from cardiovascular disease in selected countries 1970-92, men (left) and women (right), aged 45-74 years. Abbreviations: Rus = Russia, Hun = Hungary, Cze = Czechoslovakia (after 1992, Slovakia + the Czech Republic), Fin = Finland, Por = Portugal, Den = Denmark, E&W = England and Wales, Spa = Spain, Gre = Greece (From Sans et al. European Heart Journal (1997) 18: 1231-1248)

Cardiovascular diseases are the major causes of death in adults in most developed and many developing ones, and are now the commonest cause of death worldwide. ¹ These disorders also lead to substantial morbidity and disability and are a main source of the rising cost of health care. While the incidence of coronary heart disease (CHD) is falling in Western Europe, North America and Australasia, its incidence has been increasing at alarming rate in Central and Eastern Europe, including many parts of the former Soviet Union (Figure 1). The increasing westernization of life in Asia may well lead to an increase in CHD in this part of the world too, in the short to medium term .

Cardiovascular disease is by no means rare in the developing world. Even in Africa south of the Sahara, where short life expectancy due to infections and malnutrition has been the rule, increasing tobacco use, coupled with the existing high prevalence of hypertension, may imminently bring about a steep increase in cardiovascular deaths, over and above the present mortality due to cardiomyopathies, rheumatic fever and malnutrition.

Therefore, the need for effective preventive strategies against cardiovascular diseases has become urgent. Fortunately, this coincides with two favourable events.
Our knowledge of effective preventive measures has grown dramatically in the past 5-10 years, and, during this time, much has been learned about how to apply preventive strategies against cardiovascular disease, both at the population and the individual level