NHS needs to implement coronary risk reduction for the 10% of population at high risk

A consensus seems to exist that people with a 30% risk of a coronary event in 10 years should be treated, since the benefits greatly outweigh the harms. But in their discussion of the policy issues raised by the use of absolute risk guidelines Robson et al point out that if the threshold is reduced to a 15% risk a quarter of the population aged 35-69 might be treated (p 702). They argue that concerns about cost of treatment at lower thresholds should not obscure the need to treat the 10% of the population with cardiovascular disease or a 30% risk. They call for a national programme to implement intervention for these people while policy options for those below a 30% risk are reviewed. The authors ask whether assessing this risk should be a routine addition to screening for smoking and raised blood pressure. It may not be worth measuring lipids to estimate risk as they contribute little in addition to age, sex, smoking, and blood pressure, but the cost effectiveness of this and other strategies remain to be determined.

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Relevant Article

Estimating cardiovascular risk for primary prevention: outstanding questions for primary care

John Robson, Kambiz Boomla, Ben Hart, and Gene Feder
BMJ 2000 320: 702-704. [Extract] [Full Text] [PDF]