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The publication of the new “Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)” in a supplement to Heart1 raises several questions. Should the prevention of cardiovascular disease (CVD) still be a priority for clinical practice and for health policy decision makers? If so, why? Given the recent guidelines from Europe2 and America,3–6 do we need more?
Over the past decades there has been an impressive decline in age standardised mortality due to CVD. In several European countries CVD mortality rates have more than halved, but the case for prevention remains robust. In the majority of countries, CVD is still the leading cause of premature mortality, of reduced disability adjusted life-years (DALYs), and of high direct and indirect healthcare costs.
Even if developments in acute interventions and effective drug treatment have contributed to reduced mortality, changes in health behaviour and risk factor control at the population level explain the major part of the decline.7
Risk factor control
Despite these findings, risk factor control even in subjects at highest risk—those with established CVD—remains suboptimal. Large surveys of the clinical practice of preventive cardiology, such as EUROASPIRE III8 and EURIKA,9 have shown that in spite of an increase in the use of cardioprotective drugs, many patients with CVD do not reach the target levels set in the 2007 European guidelines. Furthermore, using the National Health and Nutrition Examination Survey 1988–1994 and subsequent 2-year cycles during 1999–2008, it is estimated that the American Heart Association (AHA) target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.10 According to the World Health Organization1,1 80% of all CVD could be prevented, but apparently this remains an unrealistic vision. Clearly, the challenges facing prevention, both in public …
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