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Primary prevention is by far the most effective way of cutting deaths from heart disease but has been largely ignored by Government policy and the new GMS contract, research-ers conclude.

Three times as many lives have been saved by reducing risk factors for CHD in healthy people as by secondary prevention in CHD patients, the study found.

The research leader claimed GPs should take a broader interest in primary prevention and become 'advocates of good health'.

The findings came after the Department of Health last week suggested the next version of the quality and outcomes framework could include targets for obesity management and prevention.

Researchers analysed the halving in CHD deaths between 1981 and 2000 in England and Wales and found 45 per cent of the fall came from cuts in population levels of smoking, cholesterol and blood pressure in healthy people, and only 15 per cent from secondary prevention in CHD patients.

Of 26,665 fewer smoking-related deaths, 21,630 came from healthy people giving up and 5,035 from smoking cessation in CHD patients. Falls in cholesterol cut deaths by 2,435 in healthy subjects and 1,205 in CHD patients, and reductions in blood pressure cut deaths by 3,395 in healthy people and 575 in CHD patients.

Study author Professor Simon Capewell, professor of clinical epidemiology at the University of Liverpool, said: 'Current policies do not favour primary prevention, yet almost half the falls in CHD mortality are attributable to reductions in the major risk factors in "healthy" individuals.

'GPs' roles should be extended, to also act as advocates of good health.'

Dr Terry McCormack, deputy-chair of the Primary Care Cardiovascular Society and a GP in East Yorkshire, said: 'I'm sure GPs are concentrating on hitting the quality and outcomes framework and may take their eye off the ball when it comes to the primary prevention of CHD.'

But he said 'to some extent' primary prevention of CHD was included in the contract.

The research was presented at the Society for Social Medicine conference in Birmingham.

By Simon Crawshaw

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