BMJ 2002;325:969 ( 26 October )

Letters

Primary prevention strategies for cardiovascular disease

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EDITOR---The assumptions made by Marshall and Rouse in their study are too broad and may lead to erroneous conclusions.1 Using the Framingham equation with average values is going to stratify the population only by age, sex, and diabetes status. Such stratification is simplistic and will prove only that older people and people with diabetes are more at risk. By assuming the subjects are non-smokers Marshall and Rouse exclude the most important single weighting in the Framingham calculation. Most practices have a register of smoking status for most of their patients, so this should be included.

Marshall and Rouse admit that their method may not be able to screen all of the population, so some will lose out. By concentrating on the oldest patients and patients with diabetes first, it will not detect some who have most to lose, such as 50 year old smokers with hypercholesterolaemia and hypertension. Adding . . . [Full text of this article]
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Relevant Article

Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study
Tom Marshall and Andrew Rouse
BMJ 2002 325: 197. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Marshall, T, Bryan, S, Gill, P, Greenfield, S, Gutridge, K, Birmingham Patient Preferences Group, (2006). Predictors of patients' preferences for treatments to prevent heart disease. Heart 92: 1651-1655 [Abstract] [Full text]  
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