Pakistan is a developing country and its health delivery system is not integrated, in fact it is upside down, i.e. emphasis is on tertiary care. District and tehsil hospitals and basic health units exist mostly on paper. Here, the data regarding escalating cardiovascular diseases (CVD) is compelling. 1-2 Present situation has come about because of the inability to manage the epidemiological transformation of the population from rural to urban lifestyles. There is no debate about the imperative

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... eed of prevention. The question is: what type of preventive strategy is possible in Pakistan and to what effect? Poverty, lack of education, strong cultural biases, unplanned urbanisation and absence of health services in the community, school or workplace form a broad canvas of problems to overcome. Primary prevention aims at reducing the risk factors by means of diet control, increasing physical activities, and prohibition of smoking and alcohol to a level required to reduce the prevalence of CVD. It can be implemented in a population or community or individual. This strategy requires sustained compliance for over a 10-year period to affect positive change. Risk factor modification requires changing the lifestyle of community or the entire population. Lifestyle modification involves change in one's diet from fatty saturated to unsaturated oils, vegetables, lentils, fish, chicken, and of salt to less than 5 g /day. It involves giving up of alcohol and smoking and sedentary habits, and adopting physically active habits, risk walk for ½ hour three times per week. WHO and European guidelines provide the lower levels of risk factors for an individual or a country's risk of CVD. 3, 4 The means by which this can be achieved, is not a simple matter, rather it requires motivation to change. Motivation is generated by acquisition of knowledge regarding the risk factors associated with the causation from CVD; and the conviction that their modification will result in reduced risk of dying from heart attack and stroke. Motivation leads to generation of will to change.