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Commentary
November 18, 2009

Primary Prevention of Cardiovascular DiseaseTime to Get More or Less Personal?

Author Affiliations

Author Affiliations: Genetic Epidemiology Group, Department of Epidemiology and Public Health and the Centre for Clinical Pharmacology, University College London, London, England (Dr Hingorani); and the Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington and Center for Health Studies, Group Health, Seattle (Dr Psaty).

JAMA. 2009;302(19):2144-2145. doi:10.1001/jama.2009.1698

In the 1980s, Rose coined the term prevention paradox to describe the fact that a large proportion of cardiovascular disease (CVD) events occur among the many individuals with average risk factor values.1 He distinguished between 2 approaches to CVD prevention.1 The high-risk strategy, which aims to truncate the upper tail of the normal distribution of risk factors, focuses on individuals who are most likely to benefit personally from preventive treatment. By contrast, the population-based strategy aims to shift the entire risk distribution. At the time, the available lipid-lowering therapies were limited, none was well tolerated, and the risk-benefit profile for clofibrate, for instance, argued against its widespread use.1

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