,1111111111, ~~r:;~~~~~sfo~::7:e ~~~::~~I r:;;;~~::::c~te Coronary Heart Disease Prevention

Earlier this year a report was produced by the British Cardiac Society, which makes recommenda-tions aimed at reducing coronary heart disease (CHD). The Working Group, who produced the report state that the recommendations are based on the weight and consistency of the evidence and the likely balance of benefit and harm. They cannot be based on certainty of effectiveness. There has been a small decline in CHD mortality in England, Wales and Scotland since 1979 and this is most evident in men between 35-44 years. While it is not possible to identify the specific influences responsible, the report suggests that reduction in cigarette smoking and a healthier diet have probably contributed. However, it is recognised that multifactorial intervention trials have been very disappointing, although results of trials of lowering raised blood cholesterol or blood pressure in those at special risk are encouraging. It is also recognised that coronary atherosclerosis in adults has not yet been shown convincingly to regress, and other pathological processes leading to CHD, such as thrombosis and plaque fissure, may not be influenced greatly by control of the three main 'coronary risk factors '- cigarette smoking, raised blood cholesterol and raised blood pressure. The benefit of dietary change is supported by data from several countries but there are significant exceptions which do not fit simply with a dietary hypothesis. Sweden reports similar dietar