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

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This article has been cited by other articles:

• 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]  
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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]