Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease.
AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of c...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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2004
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| _version_ | 1797060239573385216 |
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| author | Emberson, J Whincup, P Morris, R Walker, M Ebrahim, S |
| author_facet | Emberson, J Whincup, P Morris, R Walker, M Ebrahim, S |
| author_sort | Emberson, J |
| collection | OXFORD |
| description | AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reductions in cholesterol and blood pressure. High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population. Aggressive pharmacological treatment (using statins, beta-blockers, ACE-inhibitors and aspirin) in individuals with a 10-year Framingham event risk of >or=30% (6% of population) would have reduced major CVD by at most 11%. This figure increased to 34% at a >or=20% treatment threshold (26% of population). In contrast, modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD. Taking regression dilution bias into account, 10% reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45%. CONCLUSIONS: If high-risk strategies are to have a major impact on CVD in the population, they need to be more widely used than previously envisaged. Population-wide reduction of major risk factors is needed if CVD is to be substantially reduced. |
| first_indexed | 2024-03-06T20:14:33Z |
| format | Journal article |
| id | oxford-uuid:2bb34c2e-d8a5-418a-af5a-835d9ba84db4 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:14:33Z |
| publishDate | 2004 |
| record_format | dspace |
| spelling | oxford-uuid:2bb34c2e-d8a5-418a-af5a-835d9ba84db42022-03-26T12:32:29ZEvaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:2bb34c2e-d8a5-418a-af5a-835d9ba84db4EnglishSymplectic Elements at Oxford2004Emberson, JWhincup, PMorris, RWalker, MEbrahim, S AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reductions in cholesterol and blood pressure. High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population. Aggressive pharmacological treatment (using statins, beta-blockers, ACE-inhibitors and aspirin) in individuals with a 10-year Framingham event risk of >or=30% (6% of population) would have reduced major CVD by at most 11%. This figure increased to 34% at a >or=20% treatment threshold (26% of population). In contrast, modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD. Taking regression dilution bias into account, 10% reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45%. CONCLUSIONS: If high-risk strategies are to have a major impact on CVD in the population, they need to be more widely used than previously envisaged. Population-wide reduction of major risk factors is needed if CVD is to be substantially reduced. |
| spellingShingle | Emberson, J Whincup, P Morris, R Walker, M Ebrahim, S Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title | Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title_full | Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title_fullStr | Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title_full_unstemmed | Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title_short | Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. |
| title_sort | evaluating the impact of population and high risk strategies for the primary prevention of cardiovascular disease |
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