Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review

Abstract

Background and purposeEarly this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at‐risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain.MethodsIn our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023.ResultsNo published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood‐pressure‐lowering and lipid‐lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk‐stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood‐pressure‐lowering and lipid‐lowering medications in individuals otherwise eligible for such treatment.ConclusionsPrimary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.

PreventS-MD®: a New Digital Technology to Maintain Cardiovascular Prevention in Routine Clinical Practice

“…Комплекс факторов риска (ФР), определяющих суммарный риск, складывается не одномоментно, а в результате длительного взаимодействия генетических, поведенческих, экологических и других факторов. Таким образом, очевидна необходимость дополнения стратегии высокого риска методами, не зависящими от уровня абсолютного риска, которые позволят осуществлять широкомасштабное вмешательство в континуум формирования сердечно-сосудистого риска [13].…”