Patients, families and populations at high risk for coronary heart disease

High risk for coronary heart disease may be defined and assessed in terms of absolute, relative or attributable risk. The ranges of absolute and relative risks for individuals extend from very low to very high, depending on the absence or presence of single or multiple risk factors, pre-clinical or manifest disease. Risk also varies among families and populations. A general goal is to match the intensity of intervention to the level of absolute risk. But the number of people at low or moderate risk exceeds the number at high risk and also influences attributable risk for populations. Consideration of benefits and costs of intervening is important, in relation to efficacy of treatment, risks of adverse side effects and financial costs. However, even when short-term risk is low, for example among children and young adults, it is important to make the most of opportunities to reduce risk of coronary heart disease later in life, especially for those whose relative risks are high. Approaches to reducing risk, which emphasize healthy lifestyles, are appropriate for populations and families as well as for patients and high risk individuals. Implementation of these approaches would reduce risk attributable to unhealthy behaviours.