Department of Clinical Epidemiology and Biostatistics, Second Affiliated Hospital of Medical College, Zhejiang University.
Cardiovascular Disease mortality is a leading cause of deaths worldwide. In 1961, the publication of the findings of the Framingham study provided the USA and the world at large with a huge return on the initial investment focusing on common risk factors of cardiovascular disease (CVD) such as high blood pressure, high total cholesterol, high glucose, smoking, and overweight, etc. Identification of these common risk factors fuelling the epidemic of CVD stimulated a ‘call to arms’ and the initiation of programs to attack these targets on a national scale. This has led to stunning declines in CVD mortality over the last 40–50 years in North America, Western Europe and other high income countries. Decrease in population levels of cholesterol, blood pressure, and smoking in the US account for nearly half of the decline in coronary heart disease (CHD) deaths, and wider use of effective treatments among persons with existing CVD accounts for an equal share in this decline.
In Britain, current prevention strategies for the population conducted by the Joint British Societies (JBS2) have been based on quantification of absolute short term (10-year risk) and prescription of pharmacological treatments above a threshold (20%). This ‘risk based’ approach has been successful and directs treatment of those at highest absolute risk. Recently, the 3rd iteration of the Joint British Societies (JBS) recommendations for the prevention of cardiovascular disease has been published. A unique aspect of JBS3 is the emphasis upon the lifetime risk of CVD events, so as to encompass a large pool of people in the population who have a lower 10-year risk of a CVD event but who nevertheless have a high lifetime event risk, particularly for younger patients and women, in which might be excluded from therapy based upon the ‘high risk strategy’, even though they have a high rate of significantly elevated and modifiable risk factors. The JBS3 risk calculator is a novel and exciting tool that can be used to motivate both physicians and patients to tackle the potential scourge of CVD, at a time when overt disease is not present and prevention may exert its greatest impact.