International Task Force for Prevention of
Coronary Heart Disease

CORONARY HEART DISEASE: REDUCING THE RISK

1.6 The physician's contribution to CHD prevention

The high-risk strategy of CHD prevention, i.e. the detection and management of risk factors, comes most naturally to practising doctors because of their training in therapeutic care of individual patients. Yet doctors and other health care professionals, because of their standing in the community, are also well placed to influence public opinion favourably and so to contribute to the population strategy; they can and should set an example by being seen to consume a suitable diet, to take enough exercise and to avoid smoking and obesity. Some trials of risk factor intervention in the primary care setting have yielded disappointing results. Particularly, poor success has been reported in the lowering of elevated plasma lipids by dietary measures. Incomplete response and high relapse rates are familiar experiences in the treatment of obesity. As discussed in sections 1.3.2 - Nutrition and CHD and 3.4 - Treatment of hyperlipidaemia, carefully conducted trials have established the effectiveness of lipid-lowering diets in lowering cholesterol and triglyceride levels in most individuals. However much remains to be learned about maximising dietary compliance: the necessary ingredients are a positive attitude and reasonable nutritional knowledge of the physician and/or dietician, and perserverance, repeated counselling and encouragement over a period of many months and even years.