Strategies to screen and reduce vascular risk—putting statins in the tap water is not the answer

Primary prevention of cardiovascular disease in essence refers to the need to prevent the first vascular event be it angina, myocardial infarction or stroke. The importance of prevention is at least twofold—first, that clinical events like these can be disabling to the patient and have a costly impact on society through loss of productivity or need for care and, second, that they require expensive medical care. Finally, as part of our duty of care as health professionals, the fact that the majority of the causes of cardiovascular disease are known and modifiable arguably confers a moral obligation on us to try to prevent the appearance of such diseases. However, screening and prevention are imperfect sciences and are costly, and this is the rationale behind Lawson et al 's economic comparison of mass and targeted screening strategies for cardiovascular risk in this month's issue of Heart ( see page 208 ) .1 They surmise that determining which members of the general population have a high cardiovascular risk is problematic and though mass screening of the whole population is one option, screening of subgroups of the population known to have higher rates of cardiovascular disease could identify a large proportion of those at risk at relatively low costs. Long ago Geoffrey Rose presented two approaches to prevention of disease—one based on the individual at high risk and the other on a high-risk population2—and a polarised debate between …