我国心血管病发病趋势预测及21世纪预防策略的研究

目的心血管病(CVD)已成为当今我国居民健康的主要威胁,如何有效地对其进行预防和控制已成为当务之急。本专题旨在“八五”研究的基础上继续监测我国丰要心血管病发病率、死亡率及其主要危险因素的变化趋势,以及一些传统和非传统的危险因素在心血管病发生中的作用,并对我国2010年各类人群CVD的发病水平做出合理的科学预测,在此基础上提出我国21世纪CVD预防策略。方法本专题采用的研究方法包括:疾病动态监测、危险因素动态监测、横断面研究、前瞻性观察、生态学比较和模型预测等流行病学方法。结果本专题阐明了我国近年来心血管病及其危险因素的变化趋势,以及危险因素上升可能带来的潜在威胁;并提出了我国人群血压、血脂和BMI的适宜水平,以及适合我国人群的,面向21世纪的CVD人群预防策略。结论通过本研究,为我国的心血管病预防和控制工作提供了丰富而翔实的资料,为制定适合我国国情的心血管病的预防策略提供了可靠的依据。     

北方农村人群心血管病一级预防筛查策略的评价

目的：在中国北方农村人群的前瞻性队列中,评估不同的心血管病筛查策略可获得的健康收益。方法：研究对象为6 221名基线未患心血管病的40~74岁北京房山农村人群。本研究比较的筛查策略包括：策略1,在40~74岁人群中采用《中国心血管病预防指南（2017）》推荐的筛查策略;策略2,采用中国动脉粥样硬化性心血管病风险预测研究（prediction for atherosclerotic cardiovascular disease risk in China,China PAR）风险评估模型的定量筛查策略在40~74岁人群中进行筛查;策略3,采用China PAR定量评估后在50~74岁人群中进行筛查。利用马尔科夫模型模拟将该人群根据上述不同的筛查策略进行心血管病危险分层,并根据指南中的推荐,对中危及以上人群采用生活方式干预,对高危人群额外进行药物治疗干预。比较不同筛查策略的健康收益,包括增额质量调整生命年（quality adjusted life year,QALY）、可预防的心血管病发病和死亡例数、每增加1个QALY（每预防1例心血管病发病或死亡）需筛查人数等。模型所需参数来源于本队列研究、公开发表的中国人群研究数据、Meta分析和系统综述。针对一般人群心血管病发病率的不确定性进行单因素敏感性分析,并针对风险比参数的不确定性进行概率敏感性分析。结果：与不筛查相比,采用策略1、2、3产生的增额QALY分别为498年（95%CI：103~894）、691年（95%CI：233~1 149）和654年（95%CI：199~1 108）,可预防的心血管病发病例数分别为298例（95%CI：155~441）、374例（95%CI：181~567）和346例（95%CI：154~538）。同时,采用China PAR定量评估的策略（策略2和策略3）较《中国心血管病预防指南（2017）》策略有显著的增额QALY（P<0.05）,可预防更多的心血管病发病和死亡（P<0.05）,且需筛查人数较少（策略3筛查50~74岁人群,3个指标P均<0.05;策略2筛查40~74岁人群,预防1例心血管病死亡需筛查人数这一指标P＜0.05）。采用China PAR定量的筛查策略在40~74岁人群和50~74岁人群筛查的健康收益相似。单因素敏感性分析和概率敏感性分析的结果与主要分析结果一致。结论：在北方农村人群中开展心血管病一级预防的筛查及干预是必要的,基于China PAR定量筛查的策略较《中国心血管病预防指南（2017）》推荐的筛查策略获得的健康收益更高,50岁起利用China PAR进行心血管病筛查较40岁起进行筛查可以减少筛查人数,获得相似的健康收益,适用于经济不发达地区开展筛查项目。     

Reduced 10-year risk of developing cardiovascular disease after participating in a lifestyle programme in primary care

Background: Despite well-known preventive effects for future cardiovascular disease (CVD) risk through lifestyle changes, scientific evaluations of lifestyle programmes in primary care are scarce. Moreover, structured lifestyle counselling is still not integrated in everyday clinical practice. We aimed to evaluate change in cardiovascular risk factors and Framingham 10-year risk score of developing CVD in men and women at high cardiovascular risk after participation in a structured lifestyle programme over 1 year. A single-group study was carried out with a 1-year follow-up including before and after measurements.Methods: The lifestyle programme comprised five appointments to a district nurse over 1 year, focussing on lifestyle habits based on motivational interviewing. Fasting blood samples and anthropometric measurements were obtained at baseline and 1-year follow-up. The 10-year risk of CVD was calculated according to Framingham general CVD risk score.Results: A total of 404 patients were included in the study. There was a positive change over 1 year in the total study population for all risk factors evaluated. This included improvements in weight, waist circumference, blood pressure, blood lipids, and fasting glucose. The 10-year risk of developing CVD decreased for the total population from 24.8% to 21.4% at 1 year, equivalent to a 14% decrease.Conclusions: A structured lifestyle programme in primary care contributes to significant improvements of cardiovascular risk factors and the reduction of 10-year risk for CVD for both men and women at high cardiovascular risk.     

北京市部分农村居民心血管病相关行为危险因素特点及城乡对比分析

目的 比较北京市城乡心血管疾病相关行为危险因素差别,总结部分农村居民心血管疾病相关行为危险因素特点,为制定适合农村特点的心血管疾病干预策略提供依据.方法 采取分层随机抽样方法,从昌平、顺义、房山、大兴四区随机抽取25～64岁的农村户口居民1605人,采用统一的行为危险因素监测调查表,由统一培训的调查员入户调查.结果 农村居民开始吸烟的平均年龄早于城市;农村吸烟率为33.8%,高于城市的22.7%,年龄标化率分别为34.5%、23.5%,P＜0.05;规律体育锻炼率农村为29.7%,明显低于城市的53.1%,年龄标化率分别为30.5%、53.5%,P＜0.05;每周食高脂食品、奶制品超过5 d的比例农村为5.9%和16.6%,明显低于城市的8.8%和40.6%,农村年龄标化率分别为5.5%、16.5%,城市年龄标化率分别为9.0%、40.9%,P＜0.05;肥胖率农村为16.1%,城市为7.5%,年龄标化率分别为15.9%、10.7%,P＜0.05.结论 高血压、肥胖以及缺乏运动是农村居民心血管疾病上升迅速的主要原因,因此控制血压、控制体重、规律锻炼是心血管疾病防治的重要策略.     

Report on Cardiovascular Health and Diseases in China 2021: An Updated Summary

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million patients suffer from CVD in China. The number of patients suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension are 13.00 million, 11.39 million, 8.90 million, 5.00 million, 4.87 million, 2.50 million, 2.00 million, 45.30 million, and 245.00 million, respectively. Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors, the burden caused by CVD will continue to increase, which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China. It is important to reduce the prevalence through primary prevention, increase the allocation of medical resources for CVD emergency and critical care, and provide rehabilitation services and secondary prevention to reduce the risk of recurrence, re-hospitalization and disability in CVD survivors. The number of people suffering from hypertension, dyslipidemia and diabetes in China has reached hundreds of millions. Since blood pressure, blood lipids, and blood glucose levels rise mostly insidiously, vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population. Hence, more strategies and tasks should be taken to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking, and more efforts should be made in the assessment of cardiovascular health status and the prevention, treatment, and research of early pathological changes.     

绝经妇女心血管疾病发病风险相关因素的研究进展

心血管疾病(CVD)是导致女性死亡的主要原因。女性CVD的预防已经逐渐变成女性CVD危险因素的预防。绝经女性CVD发病风险相关的危险因素包括:糖尿病、吸烟、不健康饮食、体质量超标、高血压、高血脂等。CVD严重危害妇女健康,现就近年来国内外有关绝经妇女的CVD发病风险相关因素及预防策略予以综述。     

Outline of the report on cardiovascular disease in China, 2010

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.     

同型半胱氨酸在慢性肾脏病心血管疾病发生发展中研究进展

同型半胱氨酸（Homocysteine,Hcy）是衍生于蛋氨酸代谢的一种含硫的非必需氨基酸,主要通过食物和内源蛋白质分解获取,在体内含量很少,许多因素会导致体内Hcy 的水平升高,如服用药物、蛋氨酸代谢酶的改变、维生素B12、B6、叶酸等缺乏,以及相关的肾脏损害。慢性肾脏病(Chronic kidney disease,CKD)在全世界范围内的发病率呈上升的趋势,已成为一个威胁人类健康的重要疾病。一项对44 个国家的患病率研究进行的荟萃分析估计,全球CKD 患病率为13.4%。研究表明,受CKD 影响的人群发生心血管疾病（Cardiovascular diseases,CVD）的危险性较一般人群显著增高,CKD 被认为是CVD 的独立危险因素,而CVD 是导致CKD 死亡的主要原因。由于各种传统危险因素无法完全解释这种增加的心血管风险,近年来,越来越多的研究表明非传统因素,如高同型半胱氨酸血症对CKD 患者发生心血管疾病起到了一定的作用。下面就其相关作用机制进行一系列阐述。     

Human Cardiovascular Model and Applications

Cardiovascular diseases (CVDs) can be known as a class of diseases which affect different parts of the cardiovascular system such as the heart or blood vessels. Hemodynamic signals are an important tool used by doctors to diagnose the type of CVD occurred in a patient. Diagnosing the correct type of CVD in a patient early will allow the patient to have the suitable medical treatment. Some examples of CVDs include coronary heart disease, cerebrovascular disease and peripheral arterial disease. A human cardiovascular model is developed in order to simulate different hemodynamic signals of the cardiovascular system. The hemodynamic signals include the blood pressures, flow rates and volumes in various part of the cardiovascular system. This paper presents a model which is able to simulate hemodynamic signals and they are able to represent the human arterial blood pressure accurately. Hence this model can also be used to simulate hypertensive patients in order to design control systems for regulation of blood pressure. Signal verification has been performed and the stability of the model is being investigated. Applications of the human cardiovascular model are also presented.     

我国心血管病及其主要危险因素的流行病学研究

近20多年来,为了有效地防治心血管病对我国人民健康和生命造成的危害,全国各地在心血管病流行病学领域进行了大量的研究,本文以其中的一些主要研究结果为基础,对我国心血管病负担和心血管病主要危险因素的分布特点及变化趋势进行简要陈述:1)我国人群心血管病发病特点与西方发达国家有所不同,主要表现为冠心病发病率相对较低,脑卒中发病率相对较高。2)在多数西方发达国家人群冠心病及脑卒中发病率呈下降趋势时,我国人群冠心病及脑卒中发病率却呈增加趋势。3)我国男性吸烟率居高不下。虽然我国人群平均血清胆固醇(TC)水平较低,但TC水平呈明显上升趋势。我国人群危险因素的上升变化,是影响人群冠心病脑卒中发病率呈持续上升趋势的重要因素。     

Predicted 10-year Cardiovascular Disease Risk and Its Association with Sleep Duration among Adults in Beijing-Tianjin-Hebei Region,China

Objective The study aims to predict 10-year cardiovascular disease (CVD) risk and explore its association with sleep duration among Chinese urban adults. Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling. The simplified Pittsburgh Sleep Quality Index (PSQI) and Framingham 10-year risk score (FRS) were used to measure sleep duration and CVD risk. Demographic characteristics, personal history of chronic diseases, lifestyle factors were collected using a questionnaire. Height, weight, total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were also measured. Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk. Results We included 31, 135 participants (median age 44 years, 53.02％ males) free of CVD, cerebral stroke, and not taking lipid-lowering agents. Overall, 14.05％, and 25.55％ of participants were at medium and high predicted CVD risk, respectively. Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males (OR = 1.10; 95％ CI:1.01–1.19) and increased odds of medium to high and high risk of predicted 10-year CVD among females (OR = 1.23; 95％ CI: 1.08–1.40; OR = 1.27; 95％ CI: 1.11–1.44). In contrast, long sleep had no association with cardiovascular risk. Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk. Short sleep was associated with increased odds of predicted CVD risk.     

Knowledge of heart disease risk factors among workers in a Nigerian University: A call for concern

Introduction:

Cardiovascular disease is the commonest cause of mortality worldwide. Many risk factors predate the development of cardiovascular diseases. Adequate knowledge of risk factors for cardiovascular diseases is the first step towards effective preventive strategies to combat the cardiovascular diseases burden in any population. This study aims to determine the knowledge of workers in a Nigerian University on risk factors for cardiovascular diseases.

Materials and Methods:

A cross-sectional survey of 206 academic and non-academic staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria using the Heart Disease Fact Questionnaire (HDFQ). Demographic data were taken. The lipid profile and random blood sugar were taken. Statistical analysis was done using SPSS 17.0.

Results:

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%). The mean HDFQ score was 48.6%. Only 41 (19.9%) of participants were assessed to have good knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64 (31.2%) had fair knowledge of heart disease risk factors. There was no significant difference between prevalence of CV risk factors between those with good or fair or low level of knowledge. Most participants did not have a good level of knowledge about risk factors, prevention, treatment and association with diabetes as it relates to heart diseases.

Conclusion:

Knowledge of heart disease risk factors is low among University workers in Nigeria. Effective education on heart disease risk factors and appropriate preventive strategies are indeed important to reduce cardiovascular disease burden in Nigerian University communities.     

牙周致病菌在心血管疾病中的作用机制研究进展

心血管疾病（cardiovascular disease, CVD）是全球范围内主要的致死原因,有研究指出牙周感染是CVD的独立危险因素,牙周病原体可通过直接侵袭、诱导血小板活化凝集、免疫炎症反应、菌血症、氧化应激等多种途径引发CVD。患者进行牙周干预治疗后CVD症状也得到了缓解。大量证据表明牙周病和CVD可能存在密切的关系,但牙周病是一种慢性疾病,牙周病的治疗及牙周健康的改善是一项长期工作,在临床上如何长期有效地通过预防牙周病来降低CVD的发生率是一项具有挑战的研究。本文对牙周致病菌在CVD中的作用机制方面的研究进展作一综述,有助于更好地了解CVD的发病机制,为CVD的临床防治提供潜在的靶点和新的思路。     

天津社区老年高血压患者心血管疾病危险因素分析

目的 预测老年高血压人群心血管疾病10年发病风险,为防治提供科学依据。方法 选取2016年972名老年高血压患者为研究对象并收集2017年回访资料,应用国人缺血性心血管病(ischemic cardiovascular disease,ICVD)10年发病危险评估方法对该人群ICVD 10年发病风险进行评估。结果 该人群ICVD 10年发病绝对风险2016年为12.8%、2017年为16.8%,2017年高于2016年(P＜0.01),其中高危者由59.3%升高至67.7%(P＜0.01);发病风险升高的154例患者的体质量指数、腰围、收缩压、血糖、血脂、尿素氮和肌酐均增加(P＜0.01),超重及肥胖增加,高胆固醇血症、高三酰甘油血症、糖尿病、代谢综合征、肾功能受损患病率增加(P＜0.01),提示ICVD 10年发病风险升高与这些因素的升高相关。结论 天津社区老年高血压人群心血管疾病危险因素水平较高,ICVD 10年发病风险较大,应加强对危险因素的有效干预。     

昆明市高职业压力护士心血管疾病危险因素患病分析

目的：分析昆明市某三甲医院高职业压力科室护士的心血管疾病相关危险因素的流行现状．方法对2013年8月1日至2013年11月30日昆明市第一人民医院参加体检的146名护士健康资料进行回顾性分析．结果146例参加体检的护士中111例（76%）存在不同程度的心血管疾病风险,其检出率排序依次为血脂异常人数86例（58.9%）、高粘血症66例（45.5%）、心电图异常45例（30.8%）、超重28例（19.2%）和高血压13例（9.2%）．不同科室间的血脂异常、高粘血症、心电图异常、超重和肥胖检出率有统计学意义（P〈0.05）,且以上4项检出率手术室为最高．结论三甲医院高职业压力科室护士的心血管疾病风险较高,应采取干预措施降低其风险．     

菠萝蛋白酶治疗心血管疾病的系统综述（英文）

背景：在2004年,全球估计有1710万人死于心血管疾病。根据美国心脏病协会的数据,心脏病与中风是2型糖尿病患者的首要致死及致残因素。寻找更多的安全有效的心血管疾病治疗方案对于该疾病的预防和治疗十分必要,营养补充品是可行方案之一。目的：探讨菠萝蛋白酶（一种食品补充品）对心血管疾病的预防和治疗作用。检索策略：2009年9月至2010年3月进行电子与手工检索。检索的数据库包括Ovid MEDLINE;All EBMReviews-Cochrane Database of Systematic Reviews（Cochrane DSR）、American College of Physicians（ACP）Journal Club、Database of Abstracts of Reviews of Effects（DARE）、Cochrane Central Register ofControlled Trials（CCTR）、Cochrane Methodology Register（CMR）、Health Technology Assessment（HTA）和National Health Service Economic Evaluation Database（NHSEED）;Allied and ComplementaryMedicine（AMED）、British Nursing Index and Archive、EMBASE、Health Management InformationConsortium（HMIC）、ScienceDirect和Electronic Thesis Online Services（ETHOS）。检索语言限定为英文。纳入标准：有关菠萝蛋白酶用于预防或治疗心脑血管疾病的随机对照试验、人体研究、动物研究与实验性研究。资料提取与分析：3位作者分别对检索到的文章进行文献质量评估并提取文献资料。所收集的资料包括实验种类、用药剂量、治疗周期、测量指标、研究结果、菠萝蛋白酶的特征、结果的意义与研究结论。结果：在搜索到的223篇文章中,只有6篇文章符合纳入标准。包括3项动物实验和3项人体试验。菠萝蛋白酶可用来治疗急性血栓性静脉炎,因为它可减少血液中的纤维蛋白原含量,降低血小板聚集度,有保护心脏的作用,并能够改善动脉壁的结构,避免由凝血酶所诱发的血小板聚集,减少血栓的形成。结论：迄今为止,没有菠萝蛋白酶用于心血管疾病治疗的高质量的人体研究。在1948年至2010年间所发表的有关菠萝蛋白酶与心血管疾病的研究的数量极为有限。在未来的心血管疾病研究中这可能是一个值得探索的领域。     

社区动脉硬化早期检测适宜技术应用研究

目的探讨社区人群脉搏波速度(PWV)与心血管疾病危险因素之间的关系及在社区开展动脉硬化早期检测适宜技术的意义。方法选取2009年10月—2010年2月在什刹海社区卫生服务中心就诊的患者,取其资料完整者400例作为本研究对象。按是否患有高血压、糖尿病、脑卒中、冠心病、高脂血症分为慢性病组和对照组,进行流行病学调查,收集相关临床资料并检测相关生化指标。应用日本科林公司的全自动动脉硬化检测仪VP-1000检测研究对象的肱-踝脉搏波速度(baPWV)和踝臂指数(ABI)。采用SAS 6.2统计软件进行数据分析和处理。结果慢性病组的baPWV值显著高于对照组,差异有统计学意义(P<0.01)。Logistic回归分析显示,收缩压和baPWV是慢性病的独立危险因素(P<0.01);年龄和空腹血糖是影响baPWV的独立因子(P<0.01),尤其是45岁以上人群baPWV值显著升高。对照组中有28.05%的人baPWV值异常。结论 baPWV是慢性病的独立预测因子,baPWV与年龄、空腹血糖相关;baPWV测定可作为早期诊断动脉硬化的首选和常规检查手段,适合在社区推广。     

老年糖调节受损患者合并心脑血管疾病的危险因素分析

目的探讨老年糖调节受损(IGR)患者心脑血管病变的特点及相关危险因素。方法通过回顾性分析,将114例老年IGR患者分为心脑血管病变组(病变组)61例和无血管病变组(无病变组)53例。病变组包括缺血性心脏病(IHD)患者35例、脑血管病变(CVD)患者26例。对2组患者的临床数据进行比较及回归分析。结果病变组的年龄、高血压患病率、病程、C反应蛋白水平比无病变组明显增高(P<0.05);各亚组与无病变组的比较也有相似的趋势。回归分析显示,年龄、高血压是老年IGR患者心脑血管病变的独立危险因素,同时也是IHD和CVD的独立危险因素。另外高三酰甘油血症与心脑血管病变及IHD分别独立相关。结论对于老年IGR患者,除了年龄、高血压外,高三酰甘油血症是心脑血管病变的独立危险因子。     

《中国心血管健康与疾病报告2021》要点解读

随着社会经济的发展,国民生活方式的变化,尤其是人口老龄化及城镇化进程的加速,居民不健康生活方式问题日益突出,心血管疾病（CVD）危险因素对居民健康的影响更加显著,CVD患病率和发病率仍在持续增高。2019年农村和城市CVD死亡人数分别占总死亡人数的46.74%和44.26%,每5例死亡者中就有2例死于CVD。推算中国CVD现患人数为3.3亿,其中脑卒中1 300万,冠心病1 139万,心力衰竭890万,肺源性心脏病500万,心房颤动487万,风湿性心脏病250万,先天性心脏病200万,下肢动脉疾病4 530万,高血压2.45亿。2019年中国心脑血管疾病的住院总费用为3 133.66亿元。CVD负担持续加重,特别是农村地区。由于医疗资源配置的不平衡、对疾病的认识较低及治疗的顺从性较差等原因,近几年农村地区冠心病和脑血管病的死亡率持续超过城市地区。同时也应看到,中国在CVD的防控方面也在不断进步,吸烟率下降,高血压控制率不断上升,临床诊疗水平和基础研究也有大幅进步,社区防治工作取得了一定成果,疾病后的康复工作愈发受到重视,医疗器械研发处于高速发展阶段。     

Prevention of coronary heart disease among Indians: focus on primary prevention

Epidemiological transition with increasing life expectancy and demographic shifts in population age-profile combined with lifestyle related increases in the levels of cardiovascular risk factors is accelerating coronary heart disease (CHD) epidemic in India. As prospective cohort studies for evaluation of coronary risk factors do not exist, urban-rural differences in prevalence of coronary risk factors and case-control studies provide important information regarding coronary risk factors that need prevention to control the CHD epidemic. The risk factors more in urban Indians or associated with increased risk in case-control studies are: Sedentary lifestyle, smoking, truncal obesity, hypertension, hypercholesterolaemia, impaired glucose tolerance, insulin resistance and diabetes. Primordial prevention ie, prevention of risk factors can be achieved by encouragement of positive health behaviour and promotion of the concept of health as a social value. Special target groups are children, adolescents, family unit, under-privileged and high-risk groups. Behavioural and environmental changes relevant to primordial prevention are changes in eating patterns, drinking, smoking, physical activity and stress management. Primary prevention focuses on population and on high-risk groups. Specific high-risk subjects are those with family history of CHD, hypertension or diabetes or those having sedentary lifestyle, obesity, truncal obesity and biochemical coronary risk factors. The interventions are smoking cessation, increased physical activity, weight regulation, blood pressure control, lipid regulation and diabetes management.