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Cardiovascular disease: different strategies for primary and secondary prevention?
  1. F D R Hobbs
  1. Correspondence to:
    Professor Richard Hobbs
    Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, UK;

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Despite public apprehension over the risks of developing cancer, in most countries the public has more to fear from cardiovascular disease (CVD). Coronary heart disease (CHD) and stroke, the principal manifestations of CVD, are the first and second most common causes of death worldwide.1 The World Health Organization predicts that, by 2020, coronary heart disease will become the world’s most important cause of death and disability and, further, the most important cause of premature death. Overall CVD therefore leads to substantial patient morbidity and, through the management of stroke and heart failure, results in the highest healthcare utilisation costs for any disease in many countries. Strategies to prevent CVD therefore have global significance and should be as high a priority for healthcare systems (if for no other reason than to reduce expenditure) as for individuals. Both primary and secondary prevention strategies are essential, the former at least partly justified by one in five coronary events presenting with sudden death as the first and only symptom.


CVD represents a cluster of disorders, associated with complex interactions between multiple risk factors. The risk factors, or co-morbidities, that lead to enhanced risk of developing CVD have been recognised for many years.2 The main CVD risk factors include smoking,3 hypertension,4 and dyslipidaemia.5 Further major influences relate to familial risk (premature CVD in men before 55 years old and women before 65 years old) and diabetes, which results in a gross acceleration of the pathological processes involved in CVD. Other important predisposing factors include diet, physical inactivity, obesity, and genetic influences. Although more than 200 risk factors for CHD have now been identified, the single most powerful predictor of CHD risk is abnormal lipid values. All of these risk factors are multiplicative, acting to exaggerate the damage caused by each …

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    BMJ Publishing Group Ltd and British Cardiovascular Society