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November 2017

The Benefit Model for Prevention of Cardiovascular Disease: An Opportunity to Harmonize Guidelines

Author Affiliations
  • 1Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
  • 2Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University, Durham, North Carolina
  • 3Royal Victoria Hospital–McGill University Health Centre, McGill University, Montreal, Québec, Canada
  • 4Deputy Editor for Statistics, JAMA Cardiology
JAMA Cardiol. 2017;2(11):1175-1176. doi:10.1001/jamacardio.2017.2543

Current guidelines for cardiovascular disease (CVD) prevention use 2 different strategies. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines,1 with a few exceptions such as markedly elevated low-density-lipoprotein cholesterol (LDL-C) or diabetes mellitus, base their primary preventive treatment recommendations on calculated 10-year CVD risk. In contrast, blood pressure treatment recommendations are based on levels of systolic and diastolic blood pressure, with no explicit inclusion of estimated CVD risk.2 In 2016, the consequences for the US population of the benefit model for prevention, which includes both the predicted risk and the reduction in that risk expected with treatment, have been explicated.3 In this Viewpoint, we contrast the implications of benefit vs risk-based prevention strategies, demonstrate why the benefit model offers the optimal approach to CVD prevention, and explain how it needs to be extended to other risk factors.

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