BMJ 2000;320:659-661 ( 11 March )

Editorials

Guidelines on preventing cardiovascular disease in clinical practice

Absolute risk rulesbut raises the question of population screening

Papers pp   671 , 676 , 677 General practice pp   680 , 686 , 690 Education and debate pp   702 , 705 , 709

The first 150 words of the full text of this article appear below.

Ten years ago clinical recommendations on preventing cardiovascular disease focused primarily on managing individual risk factors, particularly raised blood pressure and cholesterol concentrations. Typically, separate guidelines were developed for each risk factor and treatment was recommended when that factor was above a specified level.¹ The recommendations were informed mainly by evidence from cohort studies showing increased relative risks of cardiovascular disease in people with raised levels of the risk factor² and by evidence from randomised controlled trials showing relative benefits from lowering the factor. ^{3 4}

Over the past decade we have witnessed a remarkable change from these recommendations based on relative risk to ones based on absolute riskthat is, incidence. If Geoffrey Rose, arguably the most influential cardiovascular disease epidemiologist ever, was living today, he would support this revolution, which echoes his 1991 advice that "All policy decisions should be based on absolute measures of risk; relative risk is strictly for . . . [Full text of this article]

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