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Background to the debate: Coronary artery disease is a major cause of death worldwide. Two very different approaches have been proposed as a way of reducing these deaths. The “high risk” approach uses tools such as risk factor scoring and carotid ultrasound to try and identify those at highest risk, and then treats them aggressively. The “population” approach aims to shift the distribution of risk factors across a population in a beneficial direction with the goal of reducing heart disease in the whole population.

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