Nutrition and Coronary Heart Disease
There are several reasons why such an approach is intuitively appealing. If the
interventions can target high-risk groups, high-risk individuals are targeted without their
needing to undergo a screening process. The SWSAHS demographics show that there
are a large number of people in high-risk groups. Further, there may be equity reasons
for targeting high-risk groups. Finally, the types of interventions that would target high-
risk groups are within the domain of the range of services that SWSAHS currently
provide.
The Mass Media Intervention
A number of economic evaluations have shown that this type of intervention is the most
cost effective (Hall et al, 1988; Kristiansen et al, 1991; Crowley et al, 1995). Section 2
discusses the previous CEAs on nutritional interventions in more detail.
One of the main reasons for conducting a mass media (or whole population) campaign
is that the vast majority of CHD deaths occur in the wider community, rather than a
subset of it. For example, even though the risk of CHD is much greater for people with
hypertension, the vast majority of CHD deaths occur outside this group.
The HospitalZRehabilitation Based Intervention
In the SWSAHS there are approximately IOOO hospital separations for myocardial
infarction (ICD : 410) every year. In addition there are approximately 4650 hospital
separations in the SWSAHS for other CHD (ICD: 411-414) diagnosis and procedures
(SWSAHS 1997). Survivors of myocardial infarction have an increased risk of
recurrence and death (Lancaster and Sleight 1996) four to eight times that of the general
population.
There is reliable evidence on the effectiveness of rehabilitation programs, such as the
one described above, however, compliance with the rehabilitation programs is a
concern. A meta-analysis of ten cardiac rehabilitation trials found that participants
reduced their risk of CHD by approximately 25 % (Lancaster and Sleigh, 1996).
CHERE Project Report 11 - November 1999
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