Encouraging everyone to follow a healthy, cholesterol-lowering diet and quit smoking would do more to cut the number of deaths from Heart disease than targeting people who already suffer from it, say researchers.

Coronary heart disease (CHD) is the most common cause of death in the UK and US. The latest figures from the British Heart Foundation show that CHD claimed 114,000 lives in the UK in 2003.

Amongst the foods that should be topping the menu for people wanting to maintain a healthy heart are fruits and vegetables - many of which contain plant sterols, which are also added to foods and beverage products marketed for heart health, and oily fish.

A number of studies have also shown that the Mediterranean Diet, which abounds vegetables, fruits, cereals, and a low intake of meat and dairy products, with a high ratio of monounsaturated fatty acids (mostly olive oil) to polyunsaturated fatty acids, has a protective effect on the heart.

As UK and US government policy currently aims at preventing mortality in patients who have heart problems (a strategy known as secondary prevention), people are not generally advised to follow a cholesterol-lowering diet until a problem has been diagnosed.

But researchers from Dokut Eylul University School of Medicine and the University of Liverpool argue in a study in the British Medical Journal, published online today, that targeting people who are currently healthy (primary prevention) could prevent four times as many deaths as secondary prevention.

They reached this conclusion by synthesizing data for the adult population in England and Wales, describing the number of Coronary heart disease (CHD) patients, treatment uptake, and the effect of reducing cholesterol, smoking and blood pressure in people with and without CHD.

They found that CHD deaths fell by 54 percent between 1981 and 2000. Around half of the 68,230 fewer deaths in 2000 were attributed to cholesterol, smoking and blood pressure reductions across the whole population, but 81 percent fewer deaths were seem in people without recognized CHD, compared to 19 percent of those with CHD.

In particular, an estimated 4,565 deaths were prevented or postponed in the general population through dietary measures to reduce cholesterol, compared to 1,205 in CHD patients.

The figures for the reduction of cholesterol using statin drugs were considerably lower - 145 in the healthy people and 1,205 in CHD patients.

In recent times, emphasis has shifted away from cholesterol control using Statin drugs, which come with some potentially dangerous side-effects, to dietary approaches.

The researchers admit that both primary and secondary prevention interventions are probably necessary to maximize population health, but they say that a better understanding of the relative contributions of the two approaches is needed, to inform future policy options.

Their conclusion is that “future CHD policies should prioritize population-wide tobacco control and healthier diets”.