1. Introduction

In recent years evidence from randomised controlled trials and meta analyses has strengthened our understanding of the effectiveness of lifestyle and therapeutic interventions in reducing coronary and other atherosclerotic risk. The European Societies of Cardiology, Atherosclerosis, and Hypertension joined forces to publish recommendations on the prevention of coronary heart disease (CHD) in clinical practice in 1994, and these were updated in 1998.1 This valuable collaboration between professional societies with a common interest in reducing the burden of cardiovascular disease in Europe encouraged the British Cardiac Society to cooperate with the British Hyperlipidaemia Association and the British Hypertension Society in preparing national recommendations, which have also been endorsed by the British Diabetic Association. Until now each society has worked independently, publishing separate guidelines on coronary prevention,2 and the management of hyperlipidaemia,3 ,4 and hypertension.5 This professional isolation is mirrored in clinical practice where a patient with angina can be under the care of specialists in cardiology, hypertension, lipids, and diabetes all in the same hospital. Too often the cardiologist restricts his view to coronary anatomy and ventricular function, and other specialists to management of single risk factors, and by so doing can overlook the other major determinants of a patient’s prognosis.

In putting forward joint recommendations on coronary prevention it is hoped that collaboration between professional societies will result in a more unified, and hence effective, approach to prevention of CHD in clinical practice. It is also appropriate to offer British recommendations in view of the substantially higher levels of CHD, and other atherosclerotic diseases, and their associated risk factors currently prevalent in Britain compared with many other European countries. To achieve a common approach it is necessary to include all cardiovascular risk factors, rather than focusing on a single risk factor and treating it in …