While neither Williams and Wynder in this issue (p 2196) nor we are in a position to set national policy to prevent coronary heart disease, it is useful to discuss, with the goal of defining, what could reasonably be included in such a policy at the present stage of our knowledge.
Williams and Wynder begin with the currently popular assumption, not yet proved, that the frequency rate of heart attacks in adults may be decreased by instituting preventive programs in childhood. This assumption arose in part from the realization that preventive measures started in middle-adult life did little to decrease heart attacks.1 It is also known that atherosclerotic lesions begin in childhood and can be fairly advanced by the age of 20 years. Therefore, a way to prevent heart attacks is to begin a "moderate intervention program" in childhood.
The questions we raise are (1) is the intervention suggested