Primary prevention of cardiovascular disease

Two linked analysis articles (doi:10.1136/bmj.c6244; doi:10.1136/bmj.c6312) and one research study (doi:10.1136/bmj.d108) on aspects of prevention of cardiovascular disease raise concerns as to what measures are the most efficient and cost effective.1 2 3 Despite major initiatives and improvements in the prevention of cardiovascular disease, increases in obesity and diabetes have the potential to worsen rather than improve future outcomes.

Severe hypertension and familial hypercholesterolaemia are single risk factors for cardiovascular disease, but blood pressure and cholesterol are measured on a continuous scale and risk of cardiovascular disease is multifactorial. Guidelines from the United States and United Kingdom cover the identification of people who are at high risk from multifactorial causes, but these guidelines are due for revision shortly⇓.4 5 6

Most events occur in people with modest values of cholesterol (or low density lipoprotein-cholesterol) that overlap with those seen in people without cardiovascular disease, and Hingorani and Hemingway debate whether to target high risk people or screen whole populations.1 They favour wider eligibility for treatment with inexpensive generic statins and a wider population effort to reduce cardiovascular disease. However, a previous editorial in the BMJ concluded that although …