Impact of an interventional program on the reduction of modifiable coronary risk factors in family practice at El-Salam district in Port Said

Abstract

Cardiovascular diseases (CVDs) are public health concerns around the world, particularly coronary or ischemic heart disease (CHD) (1). CHD remains the leading cause of adult death in many industrial societies (2r

According to the Morbidity and Mortality Chartbook on Cardiovascular Diseases conducted by the National Heart, Lung and Blood institute in the United States on 1990; Death rates for CHD for ages from 35 to 74 years were found to be 100 for females and 230 for males in the United States, 110 for females and 200 for males in the middle east region, and finally 10 for females and 30 for males in Japan and China. In Egypt, mortality rate due to cardiovascular diseases represent 47% of all causes of mortality which represent the first and most common cause of death (3).

Much about coronary heart disease causes and prevention has been learned from diverse research methods, including clinicopathological observations, laboratory-experimental studies, population studies and clinical trials (4)

The rational and the potential for preventive practice are based on several well-established relationships: between risk factor levels and CHD, between health behaviors and risk factor levels, and between culture and mass health behaviors (5)

The five major modifiable risk factors for the development and progression of coronary heart disease are hypertension, hyper-cholesterolemia, habitual smoking, physical inactivity and obesity (6)

In Egypt the prevalence of smoking is 20%, the prevalence of hypertension is 26.3% and the prevalence of DM in urban area is 5.7% and in rural areas 4.1% (7). The prevalence of obesity is 50.2% in Egypt (8)

Hypertension and cigarette smoking have been clearly associated with an increased risk of CHD events, and their modification has been proven to be highly effective in the primary and secondary prevention of CHD. For other highly prevalent risk factors, such as lipid abnormalities, obesity and physical inactivity, evidence of an independent association with CHD risk has been demonstrated by the majority of observational studies. However, definitive proof from controlled clinical trials of the beneficial effects of their modification is still lacking (9).

Where adult heart diseases pervade the major part of the United States population and other industrialized cultures, various epidemiolgic strategies of prevention are needed. A high-risk, clinical approach can be applied to individuals with heart disease or to individuals with underlying risk factors. Primary and secondary prevention are both important and should be implemented by primary care physicians (10).