The Prevention Of Cardiovascular Disease: Have We Really Made Progress?

Thomas A. Pearson


Health Affairs. 2007;26(1):49-60. 

In This Article

Abstract and Introduction


Despite reductions in cardiovascular disease (CVD) mortality, current evidence suggests that CVD is not being prevented but, rather, is being made less lethal. Evidence based guidelines have been developed for secondary, primary, and community-based prevention. To improve compliance with secondary prevention guidelines, programs must better organize and monitor care. Primary prevention requires assessment of risk in asymptomatic people, to yield cost-effective benefits. CVD prevention at the societal level should target deleterious behavior in community settings, using effective public health interventions. Policy options that involve multiple preventive approaches offer the best opportunity to minimize the economic and social burdens of CVD.


Cardiovascular disease (CVD) is largely preventable, based on several lines of evidence. First, heart disease and stroke mortality rates vary greatly among countries.[1] Second, several studies of people without established CVD risk factors (cigarette smoking, diabetes mellitus, elevated blood pressure, elevated blood cholesterol, and so forth) demonstrate exceptionally low rates of CVD incidence.[2] Third, studies of people without deleterious health behavior (tobacco use, sedentary lifestyle, high saturated fat and cholesterol in the diet, and excess body weight) suggest that a large proportion of CVD incidence could be prevented by lifestyle modifications alone.[3] Therefore, nihilistic assumptions of the inevitability of CVD development in individuals or societies are unwarranted. The intent of this paper is to describe the various approaches to CVD prevention, examine the extent to which they have been implemented, and examine policy approaches to improving that implementation.


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