Are guidelines on cardiovascular risk prevention comprehensive enough? Focus on the 2005 Joint British Societies? Guidelines

Cardiovascular disease (CVD) has burgeoned from a relatively minor disease worldwide to a leading cause of morbidity and mortality. More worryingly, by the year 2020, CVD is projected to surpass infectious disease as the world’s leading cause of death and disability [1]. This is partially owing to improved public health measures and medical care leading to longer life spans and reduced mortality from other causes; although a substantial portion can be attributable to adverse lifestyle changes accompanying industrialization, urbanization and increased discretionary income, increasing the degree of exposure to CVD risk factors. In absolute terms, the increase in CVD may translate into major clinical and economical implications, since CVD is not only a leading cause of global mortality, accounting for almost 17 million deaths annually [2], but also has massive economic implications. In the UK alone, for example, CVD-related costs in 2004 amounted to approximately GB£29 billion [3]. In order to blunt the effect of the global explosion in CVD, it is crucial to understand and reduce the global increase in CVD risk factors. For over 10 years, attempts have been made to define the problem and promote comprehensive action plans and guidelines. In 1996, the European Action on Secondary Prevention by Intervention to Reduce Events (EUROASPIRE) I survey, involving patients with established coronary heart disease in nine European countries, confirmed the substantial potential for cardiovascular risk-factor modification [4]. This provided the impetus for comprehensive CVD prevention guidelines, such as the ‘Joint British Societies’ (JBS) guidelines in the UK. The first set of guidelines, JBS 1, were published in 1998 [5]. The main highlight of JBS 1 was coronary heart disease (CHD), with a focus on those with established CHD or at high risk of