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.18 20