BMJ  2006;332:617-618 (18 March), doi:10.1136/bmj.332.7542.617

Editorial

Preventing coronary heart disease

Does Rose's population prevention axiom still apply in the 21st century?

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

In this issue (p 659) Manuel and colleagues report how they estimated the effectiveness of three strategies to lower blood cholesterol concentrations in Canadians adults.¹ A "population" strategy assumed that blood cholesterol could be lowered by 2% in the whole population and deaths from coronary heart disease by 2.7%. The two other strategies were patient based, assuming that prescribing statins to subgroups of people at high risk of coronary heart disease would reduce their risk by 27%. A "single risk factor" strategy targeted patients with blood cholesterol levels greater than 6.2 mmol/l and a "baseline risk" strategy targeted those with a baseline risk of cardiovascular disease greater than 15% over five years, irrespective of their blood cholesterol levels.

Surprisingly, the population strategy, based on the axiom by British epidemiologist Geoffrey Rose that "a large number of people at small risk may give rise to more cases than . . . [Full text of this article]

Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
(rt.jackson@auckland.ac.nz)

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada H3A 1A2

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes

Rod Jackson, Sue Wells, and Anthony Rodgers
BMJ 2008 337: a1371. [Extract] [Full Text]

Hit parade
BMJ 2006 332: 1100. [Extract] [Full Text]

Preventing coronary heart disease: Patients are people, not cases

Joan McClusky
BMJ 2006 332: 793. [Extract] [Full Text]

The ground or the goal posts?

Fiona Godlee
BMJ 2006 332: 0. [Extract] [Full Text] [PDF]

Revisiting Rose: strategies for reducing coronary heart disease

Douglas G Manuel, Jenny Lim, Peter Tanuseputro, Geoffrey M Anderson, David A Alter, Andreas Laupacis, and Cameron A Mustard
BMJ 2006 332: 659-662. [Full Text] [PDF]

Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication

Hugh Tunstall-Pedoe, John Connaghan, Mark Woodward, Hanna Tolonen, and Kari Kuulasmaa
BMJ 2006 332: 629-635. [Abstract] [Full Text] [PDF]

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention

Belgin Unal, Julia Alison Critchley, and Simon Capewell
BMJ 2005 331: 614. [Abstract] [Full Text] [PDF]

A strategy to reduce cardiovascular disease by more than 80%

N J Wald and M R Law
BMJ 2003 326: 1419. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Jackson, R., Wells, S., Rodgers, A. (2008). Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes. BMJ 337: a1371-a1371 [Full text]  
• Capewell, S. (2006). Commentary: Predicting future coronary heart disease deaths in Finland and elsewhere. Int J Epidemiol 35: 1253-1254 [Full text]  
• (2006). Hit parade. BMJ 332: 1100-1100 [Full text]  
• McClusky, J. (2006). Preventing coronary heart disease: patients are people, not cases.. BMJ 332: 793-793 [Full text]  

Rapid Responses:

Read all Rapid Responses

Populations vs people

Joan McClusky
bmj.com, 22 Mar 2006 [Full text]

Editorial appears unbalanced, superficial, simplistic and misleading

Simon Capewell, et al.
bmj.com, 6 Apr 2006 [Full text]

Online poll

Find out more >>