Guidance from the joint European societies on prevention of coronary heart disease (CHD) in clinical practice recommends a common approach to lifestyle and risk factor intervention for patients with established CHD or other atherosclerotic disease, and high-risk persons in the population. Given the biology of atherosclerotic disease and its complications, the distinction between secondary and primary prevention is artificial. A patient with angina may be at lower absolute risk for a major coronary event than is an asymptomatic individual who has multiple risk factors for this...

Guidance from the joint European societies on prevention of coronary heart disease (CHD) in clinical practice recommends a common approach to lifestyle and risk factor intervention for patients with established CHD or other atherosclerotic disease, and high-risk persons in the population. Given the biology of atherosclerotic disease and its complications, the distinction between secondary and primary prevention is artificial. A patient with angina may be at lower absolute risk for a major coronary event than is an asymptomatic individual who has multiple risk factors for this disease. The European challenge in primary prevention of CHD is to persuade physicians to manage risk factors such as blood pressure and lipids in the context of absolute or total multifactorial risk. The European Societies recommend targeting individuals with an absolute CHD risk of 20% or more over 10 years for intensive lifestyle intervention and, where necessary, the use of drug therapies to achieve risk factor goals. Use of this total risk approach ensures that treatments are given to those at highest risk and therefore those who are most likely to benefit.