Primary prevention of cardiovascular disease is important as clinical events are disabling to the patient and have a costly impact on society through loss of productivity or need for care. However, screening & prevention are imperfect sciences and are costly, and the comparison of mass and targeted screening strategies is important.
Screening for vascular disease implies that there should be an effective treatment for those identified that leads to better outcomes than in those detected and treated later. Introducing such screening programmes will inevitably preferentially select the affluent, thus increasing social inequalities.
Population-wide health protection measures need supplementation with targeted screening programmes for those at particular risk. We cannot afford to continue to funnel more and more money into wider screening for diseases caused by lifestyle without also dealing with the population-level causes of those lifestyles. Equally, the continuing polarised debate in preventive health must not ignore those at the highest risk that need targeting and treatment today, whilst continuing in parallel to strive to find underlying remedies for their high risk.
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