Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease


Emberson, J; Whincup, P; Morris, R; Walker, M; Ebrahim, S; (2004) Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. European heart journal, 25 (6). pp. 484-91. ISSN 0195-668X DOI: https://doi.org/10.1016/j.ehj.2003.11.012

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Abstract

AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reductions in cholesterol and blood pressure. High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population. Aggressive pharmacological treatment (using statins, beta-blockers, ACE-inhibitors and aspirin) in individuals with a 10-year Framingham event risk of >or=30% (6% of population) would have reduced major CVD by at most 11%. This figure increased to 34% at a >or=20% treatment threshold (26% of population). In contrast, modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD. Taking regression dilution bias into account, 10% reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45%. CONCLUSIONS: If high-risk strategies are to have a major impact on CVD in the population, they need to be more widely used than previously envisaged. Population-wide reduction of major risk factors is needed if CVD is to be substantially reduced.

Item Type: Article
Keywords: Cardiovascular Diseases/*prevention & control, Cohort Studies, Health Policy, Health Promotion, Humans, Hypercholesterolemia/prevention & control, Hypertension/prevention & control, Male, Middle Aged, Primary Prevention, Prospective Studies, Research Support, Non-U.S. Gov't, Risk Factors, Cardiovascular Diseases, prevention & control, Cohort Studies, Health Policy, Health Promotion, Humans, Hypercholesterolemia, prevention & control, Hypertension, prevention & control, Male, Middle Aged, Primary Prevention, Prospective Studies, Research Support, Non-U.S. Gov't, Risk Factors
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 15039128
Web of Science ID: 220835400007
URI: http://researchonline.lshtm.ac.uk/id/eprint/12713

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