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British and American prevention guidelines: different committees, same science, considerable agreement
  1. Philip Greenland
  1. Correspondence to Dr Philip Greenland, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Chicago, IL 60611, USA; p-greenland{at}northwestern.edu

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The new “Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)” are built on a comprehensive synthesis of a vast cardiovascular disease (CVD) prevention literature.1 The document, with over 400 references, covers topics addressing alternative approaches to risk assessment, including lifetime and short term risk, age based risk, potential use of newer imaging techniques for risk assessment, circulating biomarkers, genomic contributions to risk, and a multitude of approaches to risk reduction treatments. The JBS3 is closely linked to a draft document2 containing nearly 300 references and numerous data summaries on cardiovascular risk assessment and modification of blood lipids for the primary and secondary prevention of CVD from the National Institute for Health and Care Excellence (NICE). In these two documents, nearly every important topic relating to cardiovascular risk and treatment is addressed. It is obvious that great care and thought went into the preparation of these important documents, and they deserve attention and careful study by primary care physicians, cardiovascular specialists, behaviour change experts, and prevention scientists worldwide.

The new British guidelines, published only 4 months after the release of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines3 ,4 on risk assessment and lipid lowering, inevitably invite comparisons of these two literature summaries with accompanying clinical advice. In light of numerous specific criticisms that immediately faced the ACC/AHA guidelines, it is worthwhile to examine carefully the similarities and differences between these guidelines. It is striking to me how similar they are, yet some important differences are also instructive.

Risk calculation

In regard to the issue of risk calculation, both the ACC/AHA and JBS3 recommend the use of a risk calculator based on traditional risk factors that are commonly and relatively easily measured. Both guidelines consider the use of additional tests including imaging procedures (eg, coronary …

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