BMJ  2006;332 (18 March), doi:10.1136/bmj.332.7542.0-f

Editor's choice

The ground or the goal posts?

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

To anyone who has been a medical student, Geoffrey Rose is perhaps best known for saying that a small shift in risk across a whole population will prevent more deaths than treating only those at high risk. The question taxing some of our authors this week is whether this axiom still holds true, and specifically what it means for our efforts to prevent illness and death from coronary heart disease.

Using Canadian population data from the 1990s, Douglas Manuel and colleagues tested three strategies for reducing coronary heart disease (p 659): lowering cholesterol across the entire population; treating only those with raised cholesterol levels; and giving statins to people at high baseline risk regardless of their cholesterol level, which is what the New Zealand guidelines, and others, recommend.

They found that overwhelmingly the most effective strategy was to treat people at high baseline risk. Does this mean that . . . [Full text of this article]

Fiona Godlee, editor

(fgodlee@bmj.com)


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