Multiple risk factor interventions for primary prevention of coronary heart disease have limited utility

Clinical question: 
How effective are multiple risk factor interventions for prevention of coronary heart disease (CHD)?
Bottom line: 
The use of "health promotion" techniques of one-to-one or family orientated information and advice on a range of life-styles (exercise, smoking cessation, diet) given to people at relatively low risk of cardiovascular disease is not particularly effective in terms of reducing the risk of clinical events. The costs of such interventions are high and it seems likely that these resources and techniques may be better used in people at high risk of cardiovascular disease where evidence of effectiveness is much stronger.
Caveat: 
In some cases, risk factor changes may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement and use of self-reports of smoking.
Context: 
Many countries attempt to reduce mortality and morbidity from CHD by using primary prevention programmes. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded.
Review CD#: 
CD 00156
PEARLS No: 
59
Date: 
April, 2008
Authored by: 
Brian R McAvoy