The Primary Prevention of Atherosclerotic Disease: A Report of the Inter-Society Commission for Heart Disease Resources EPIDEMIOLOGIC STUDIES of the atherosclerotic dis-

eases have been so numerous in recent decades that a report on the state of the art in this field is most welcome. The report of the Inter-Society Commission for Heart Disease Resources, Primary Prevention of the Atherosclerotic Diseases (1) , provides a syn-thesis and critical analysis of these studies that is remarkable for its logic, darity, and brevity. The report also makes recommendations for primary prevention of the atherosclerotic diseases. The Commission is convinced that a diet high in saturated fat and cholesterol, hypertension, and cigarette smoking are widespread major risk factors leading to the development of atherosclerotic disease. There is somewhat less convincing evidence to indict hyperglycemia, obesity, and sedentary living as risk factors, and the role of "psycho-social tensions " is not yet clear, according to the report. A family his-tory of premature atherosclerotic disease is an im-portant determinant of risk in those persons who de-velop coronary heart disease at a young age, but familial aggregation is not prominently noted among older patients with this disease. Having critically reviewed the world literature and having assessed the evidence concerning the im-portance of postulated risk factors, what are the Commission's recommendations for primary pre-vention of the atherosclerotic diseases? By primary prevention, the Commission means "reducing first clinical episodes by preventing severe atherosclerosis and its complications, " and they go to great lengths to stress that this must be "the main strategic thrust of any national effort to control coronary heart disease during the years ahead. " They point out that one in five North American men will develop coro-nary heart disease by age 60 years, and about 35% will die during their first episode. In the face of these grim statistics a strategy of secondary or terti-ary prevention (preventing progression of the disease or rehabilitation), such as cardiac transplantation, Ed ito rials 661 Downloaded From