Primary prevention of coronary heart disease

摘要

Population screening for individuals at high risk of getting coronary heart disease is an explicit objective in primary care. The national service framework for coronary heart disease recommends that general practitioners and primary healthcare teams should identify all people at significant risk of cardiovascular disease, but who have not yet developed symptoms, and offer them appropriate advice and treatment to reduce their risk. In contrast to the current policy of maximising participation, Marteau and Kinmonth in this issue suggest that helping individuals to become involved in making informed choices may increase their motivation to make changes. When the introduction of a national screening programme is being considered, a proper scientific evaluation should occur. Wilson and Jungner's criteria are a yardstick against which a screening programme can be judged (see box). Apart from the recognition that coronary heart disease is an important health problem little evidence exists that any of the other criteria are adequately met.