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In 1961, the publication of the findings of the Framingham study provided the National Institutes of Health (NIH), the USA, and the world at large with a huge return on the initial investment. Identification of the common risk factors fuelling the epidemic of cardiovascular disease (CVD) stimulated a ‘call to arms’ and the initiation of programmes to attack these targets on a national scale. This has led to stunning declines in CVD mortality over the last 40–50 years in North America, Western Europe and other high income countries. Nonetheless, this is not the time for complacency. CVD is by far and away the leading cause of deaths worldwide; the epidemic of CVD in the low and middle income countries is rampant and the alarming increases in obesity and diabetes threaten to reverse or blunt the steady decline in CVD mortality, particularly in younger people. The focus on prevention is as imperative now as it ever has been.
This is the 3rd iteration of the Joint British Societies ( JBS) recommendations for the prevention of cardiovascular disease. Current prevention strategies tend to focus upon patients at relatively short term (10-year) risks and upon specific thresholds for pharmacologic therapies, although there is considerable variability among the different guidelines. This approach is logical and has been successful in directing therapy to those at highest risk who stand to gain the greatest benefit.
A unique aspect of JBS3 is the emphasis upon the lifetime risk of CVD events, so as to encompass a large pool of people in the population who have a lower 10-year risk of a CVD event but who nevertheless have a high lifetime event risk. Such predominantly younger patients and women might be excluded from therapy based upon the ‘high risk strategy’, even though they have a high rate of …
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