In the UK National Health Service (NHS), primary prevention of cardiovascular disease (which encompasses diabetes and renal disease too) is now achieving the status afforded to secondary prevention 10 years ago. The Department of Health vascular risk checks programme1 is welcomed to strategically reduce health inequalities, which are precipitated largely by cardiovascular disease. Cardiovascular morbidity and mortality are, in principle, preventable.2 In 2005 in England, there were 171 021 deaths from circulatory diseases (accounting for 40% of all deaths).3 Additionally, it is responsible for one-fifth of all hospital admissions and incurs an NHS expenditure of £30 billion annually. Therefore, prevention is beneficent not only to the individual but also to the wider economy. The government has recently recommended the introduction of a universal risk assessment and management programme for people aged 40 to 74 years.1 The magnitude of this task must not be underestimated, as a number of challenges will need to be addressed before such a programme can be widely implemented.

Accepting a NHS shift from illness management to health protection requires a paradigm shift in public perception. Widespread publicity and health promotion must accompany cardiovascular prevention strategies, similar to campaigns supporting initiatives such as cervical screening. The voluntary sector may launch and sustain such public campaigns, but the role and responsibility of the NHS as a partner in publicity will require clarification.

With a population aware and engaged with the principles of vascular risk assessment, next comes the issue of whom and how to target risk assessment. …