Primary prevention of CHD: Nine ways to reduce risk

Lowering cholesterol can reduce the incidence of coronary heart disease. Tr eating hypertension reduces overall mortality and is most effective in redu cing the risk of coronary heart disease in older patients. Smoking cessatio n reduces the level of risk to that of nonsmokers within about three years of cessation. Aspirin is likely to be an effective means of primary prevent ion, but a group in whom treatment is appropriate has yet to be defined. Ev idence that supplementation with vitamin A or C reduces the risk of coronar y heart disease is inadequate; the data for use of vitamin E are inconclusi ve. Epidemiologic evidence is sufficient to recommend that most persons inc rease their levels of physical activity. Lowering homocysteine levels throu gh increased folate intake is a promising but unproven primary prevention s trategy. Hormone replacement therapy was associated with reduced incidence of coronary heart disease in epidemiologic studies but was not effective in a secondary prevention trial.