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

BMJ 2008; 337 doi: (Published 28 August 2008) Cite this as: BMJ 2008;337:a1371
  1. Rod Jackson, professor of epidemiology,
  2. Sue Wells, senior lecturer in clinical epidemiology,
  3. Anthony Rodgers, professor of epidemiology
  1. 1School of Population Health, University of Auckland, New Zealand
  1. Correspondence to: R Jackson rt.jackson{at}

    The Department of Health is planning to identify and treat all adults over 40 at high risk of a cardiovascular event. Rod Jackson and colleagues argue that a well targeted programme will save many lives, but Simon Capewell (doi: 10.1136/bmj.a1395) thinks whole population approaches would be more cost effective

    Provisional modelling by the Department of Health suggests that up to 9500 heart attacks and strokes and 2000 deaths could be prevented each year by its plan to screen for and manage vascular risk in people aged between 40 and 74.1 Checks would comprise a brief history, examination, and blood test and could take place in general practices or pharmacies. The programme will be implemented in 2009-10 at an annual cost of about £250m (€315m; $465m).1 This strategy assumes that the high risk approach to preventing cardiovascular disease is effective and cost effective, which we believe to be true.

    A large World Health Organization review comparing high risk and population-wide interventions to prevent cardiovascular disease globally showed that treating high risk patients with aspirin, off-patent statins, and blood pressure lowering drugs was not only cost effective but would avert …

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