Key result
Lifetime-benefit-based allocation improves primary CVD prevention efficiency over targeting isolated risk factors.
Why the study?
The identification of high blood pressure and cholesterol as causes of CVD led to evolving screening and treatment strategies in primary prevention, with differing guideline approaches over time.
Should not yet change primary prevention practice; supports lifetime benefit models but leaves open need for randomized outcome trials.
Shortly after World War II, coronary heart disease was recognized as an epidemic.Cardiovascular disease (CVD) had become the leading cause of death in Western societies.This led to the formation of the National Heart, Lung, and Blood Institute in the United States and initiation of the seminal Framingham Heart Study in 1948.This population-based cohort study on the etiology and consequences of CVD has shed light on many of the well-known causes of CVD.In one of their initial publications in 1961, the investigators from the Framingham Heart Study introduced the concept of "factors of risk in the development of coronary heart disease", nowadays known as traditional cardiovascular risk factors [1].The identification of high blood pressure and cholesterol levels as causes of CVD led to the idea of screening and treatment thereof in otherwise healthy persons, in order to halt atherosclerosis and forestall the occurrence of cardiovascular events.Initial treatment recommendations in the 1970s and 1980s were based on the levels of the specific risk factors, with antihypertensive treatment recommended for "virtually all persons with a diastolic blood pressure exceeding 105 mmHg" [2].However, a gradual diversification then took place in preventive cardiology: hypertension guidelines remained focused on blood pressure levels, whereas cholesterol treatment guidelines moved towards more sophisticated approaches by recommending pharmacological interventions informed by the individual's cardiovascular risk based on the presence and levels of multiple cardiovascular risk factors.
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Leening et al. (2018) conducted an editorial in Cardiovascular disease. Blood pressure- and cholesterol-lowering treatments based on overall cardiovascular risk vs. Treatment based on individual risk factor levels in isolation was evaluated. Personalized treatment allocation based on overall anticipated lifetime benefits represents a more efficient approach for cardiovascular disease primary prevention than targeting isolated risk factors.
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