CVD prevention can widen inequalities

Problem can stem from targeting high-risk groups

To prevent cardiovascular disease (CVD), primary prevention aims to tackle and reduce the major risk factors that are related to tobacco control and diet. One approach to achieving this reduction is an approach that tackles those at high risk. Usually this involves population screening and, on the basis of this, those exceeding a risk threshold are given lifestyle advice and /or medication to reduce cholesterol and blood pressure. However, evidence suggests that the approach can widen socioeconomic inequalities: inequalities have been observed in screening, healthy diet advice, smoking cessation, statin and anti-hypertensive prescribing and adherence.

In order to reduce widening inequalities in this way, an alternative approach is population-wide CVD prevention – and there is increasing evidence that the population-wide approach can reduce inequalities. Actions taken include: legislating for smoke-free public spaces, banning dietary transfats, or halving daily dietary salt intake. Such strategies are generally effective and cost-saving. The authors of the study in PLoS Medicine, Capewell and Graham, conclude that screening and treating high-risk individuals represents a relatively ineffective CVD prevention approach – and one that typically widens social inequalities.

Source: PLOS Medicine, 24 August 2010.

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