期刊
EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION & REHABILITATION
卷 16, 期 5, 页码 541-549出版社
SAGE PUBLICATIONS LTD
DOI: 10.1097/HJR.0b013e32832b38a1
关键词
cardiovascular disease; community-based interventions; high-risk strategy; population strategy; primary prevention
资金
- British Heart Foundation [RG/08/013/25942] Funding Source: researchfish
- Medical Research Council [G0500920] Funding Source: researchfish
- MRC [G0500920] Funding Source: UKRI
Background Options for the prevention of cardiovascular disease, the greatest global cause of death, include population preventive measures (the Rose approach), or specifically seeking out and managing high-risk cases. However, the likely benefit of a population approach has been recently questioned. Objective To compare the estimated effects of population strategies at varying levels of population-wide risk factor reduction and high-risk strategies at varying rates of screening uptake on cardiovascular disease mortality. Methods Data (of 109 954 participants) were pooled from six European general population cohort studies [the high-risk cohorts from the SCORE (Systematic COronary Risk Evaluation) dataset]. The effects of various population and high-risk strategies for the reduction of risk factors were estimated by calculating the change in 10-year risk of cardiovascular disease mortality (SCORE risk) before and after the particular intervention. Risk factors studied were: total cholesterol, blood pressure and smoking. Results At population level, if a 10-year reduction of blood cholesterol level of 10%, a BP reduction of 10% and a 10% reduction in the prevalence of smoking is considered possible, then 9125 lives per million of the population would be saved over 10 years. In contrast, an approach that treats all high-risk individuals with a polypill containing statin, three half-dose antihypertensives and aspirin, with a 20-80% uptake, would save 1861-7452 lives per million. However, the high-risk estimates are very optimistic, as their achievement would require complete compliance. Conclusion High-risk and population strategies are complementary. These estimates of the benefits of each may be useful to health planners, when combined with their local knowledge. Recently, benefits of population strategies have been underestimated. Eur J Cardiovasc Prev Rehabil 16:541-549 (C) 2009 The European Society of Cardiology
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