In Reply: We agree with Dr Pletcher and colleagues that development of policy for the primary prevention of CVD in the United States and elsewhere will require the explicit integration of the best available evidence from population studies, intervention trials, and studies evaluating the comparative performance of the available screening strategies.
Although many of the estimates needed to populate decision models are already available, there has been relatively little comparative work on the performance and cost-effectiveness of available screening tests and risk scores. Also, the preferences of populations that might be targeted for primary prevention have yet to be adequately evaluated. The wide cost differential between generic and proprietary statins also needs to be considered.
Hingorani AD, Psaty BM. Modeling Cardiovascular Disease Prevention—Reply. JAMA. 2010;303(9):835. doi:10.1001/jama.2010.189