A survey in general practice1 has shown that 90% of patients with previously identified coronary heart disease have at least one and usually two or more lifestyle related cardiovascular risk factors such as smoking, poor diet or a sedentary lifestyle. These risk factors are likely to have contributed to their heart disease and, following a myocardial infarction (MI), may inhibit recovery and increase the chance of reinfarction. It is easy to be unduly pessimistic about lifestyle change. Many people change their lifestyle for health reasons. There are more ex-smokers than smokers in the UK and most of these ex-smokers stopped without professional help. On the other hand a sizeable proportion of the population are aware of the dangers of a high fat diet without apparently being either willing or able to do much about it.

It has been know for some time that many smokers stop smoking after an MI; perhaps as many as 45% of patients, which is between two and four times the success rate of antismoking clinics for the public in general. However the position is less satisfactory for other risk factors. Patients might become less active after an MI (partly because of the consequent physical impairments and change in work patterns). While there is some evidence that patients reduce self reported saturated fat intake in the year following an MI these changes can be small and are often not reflected in changes in lipid levels. Despite this, immediately after an MI is a good time to attempt to change behaviour. People change their behaviour because of some significant change in their life or their thinking. An MI is for most patients a major life threatening event that …