ABSTRACT
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death in developed countries, although mortality rates have fallen in the last 30 years (Fig. 1) (1-3). However, the increasing prevalence of obesity appears to be slowing the decline in the incidence of coronary disease possibly via the development of type 2 diabetes mellitus with its associated features. Reductions in major risk factors and improvements in medical therapies have contributed substantially to the fall in mortality, further emphasizing the importance of preventive strategies (1,5). Primary prevention strategies are aimed at delaying or preventing new-onset coronary heart disease. Secondary prevention denotes therapy to reduce recurrent coronary heart disease events and decrease coronary mortality in patients with established coronary heart disease. Some patients without known CVD have a risk of subsequent cardiovascular events that is comparable to that seen in patients with established disease. There is, therefore, only a slim distinction between secondary prevention and high-risk primary prevention. Both groups of people require aggressive management with a combination of effective lifestyle modification and medication.
