Possibilities of a preventive approach to coronary heart disease starting in childhood

. Promotion in youth of lifestyles that are likely to result in optimum levels of cardiovascular risk factors is the basis for early prevention of cardiovascular diseases and promotion of health. Health behaviour is closely linked to the general lifestyle of any community. Thus for any long‐term major change, a community‐based approach is essential. Experience from the North Karelia project indicates that through a comprehensive community‐based programme, health behaviour and risk factor levels of a whole country could be changed, and that resulted in reduction of coronary heart disease (CHD) in the area. Studies among children carried out as part of the North Karelia project have shown that children's smoking rates and nutrition habits can be influenced and their serum cholesterol levels can be modified. At least in Finland, family‐based practical counselling and provision of Social support seems to be an effective strategy in changing the nutrition habits of both adults and children. No evidence has been observed to indicate that this type of intervention would have any harmful emotional consequences among children. A study to show the impact of risk factor modification on coronary heart disease risk in adulthood is hardly feasible and, instead, studies to test the feasibility and effects of different intervention approaches for influencing health related behaviour and risk factors in children and adolescents should be emphasized.