Opportunities for control of coronary heart disease in Australia

Objective: To estimate the number of coronary events that could be prevente d in Australia each year by the use of preventive and therapeutic strategie s targeted to subgroups of the population based on their levels of risk and need. Methods: Estimates of risk reduction from the published literature, prevale nce estimates of elevated risk factor levels from the 1995 National Health Survey and treatment levels from the Australian collaborating centres in th e World Health Organization's MONICA Project were used to calculate numbers of coronary events preventable among men and women aged 35-79 years in Aus tralia. Results: Approximately 14,000 coronary events could be avoided each year if the mean level of cholesterol in the population was reduced by 0.5 mmol/L, smoking prevalence was halved and prevalence of physical inactivity was re duced to 25%. This represents a reduction in coronary events of about 40%. Even with less optimistic targets, a reduction of 20% could be attained, wh ile the achievement of some internationally recommended targets could lead to almost 50% reduction. In the short term, aggressive medical treatment of people with elevated levels of risk factors and established coronary disea se offers the greatest opportunity for reducing coronary events. Conclusion: A comprehensive approach to reduce levels of behavioural and bi ological risk factors and improve the use of effective treatment could lead to a large reduction in coronary event rates. In the long term, primary pr evention - especially to reduce smoking, lower cholesterol levels and incre ase exercise - has the potential to reduce the population levels of risk an d hence contain the national cost of coronary disease.