CORONARY HEART DISEASE AND STROKE: HEALTH PROMOTION

Health promotion in older people for the prevention of coronary heart disease and stroke

Background

The aim of this review was to define the role of health promotion for older people, that is people aged 55 years and above, in the area of coronary heart disease (CHD) and stroke prevention. In the context of this review, the role of health promotion in the prevention of disease through lifestyle modifications was considered, although it was recognised that health promotion involved health education and health protection.

Findings

The evidence of the effects of medical treatment is consistent and strong. Antihypertensive drug therapy is effective in reducing CHD and stroke mortality among mild to moderate hypertensives up to the age of 80-85 years.

Drug treatment for high blood cholesterol is effective in reducing CHD mortality in those at high CHD risk but its appropriateness in low CHD risk populations is undetermined, although drug therapy in such people is unlikely to be cost-effective.

Single lifestyle interventions: non-pharmacological treatments are capable of lowering blood pressure in people with hypertension but their effects on disease events are not known; the most effective treatment is weight reduction.

Low fat diets, if strict enough, are capable of lowering blood cholesterol levels but the typical dietary counselling used in primary care has only a small effect. The effects of low fat diets on disease events cannot be ascertained with certainty. Rigorous inclusion criteria adopted in this report result in the demonstration of small and statistically insignificant reductions in total and CHD mortality but a significant reduction in non-fatal myocardial infarction.

Multiple interventions: The pooled results of several large trials among general and working populations of the effects of a wide range of interventions, including exercise, weight loss, anti-smoking, dietary changes, together with medical treatment for high blood pressure and for high blood cholesterol show that the effects on disease events are statistically insignificant. Multiple interventions do produce risk factor reductions, but these are generally small compared with the reductions achieved by medical treatments.

Multiple non-pharmacological interventions, particularly exercise and anti-smoking advice, among men who have recently suffered a myocardial infarction are effective in reducing total and CHD mortality.

Conducted by: Royal Free Hospital School of Medicine in collaboration with CRD

Publications

Ebrahim S, Davey Smith G. Health promotion in older people for the prevention of coronary heart disease and stroke. London: Health Education Authority; 1996

Funding

The Health Education Authority (HEA) commissioned a series of reviews to identify the effectiveness of interventions aimed at promoting a variety of aspects of health and well being. This review was part of that series and was carried out in collaboration with CRD.