the British family heart study and OXCHECK, in which there was little benefit despite unrealistically heavy nurse commitment.
There are, however, key differences between primary and secondary prevention.
First, the former relies heavily on modifying lifestyle, whereas secondary prevention includes a large component of medical treatment; we found that medical treatment was easier to change than lifestyle. Secondly, the
absolute benefits of any changes are greater in secondary prevention because the target population
is at higher risk. Small changes are therefore more important. Both of the large primary prevention studies reported more benefit for
higher risk patients.