Primary prevention of cardiovascular disease: new guidelines, technologies and therapies

Duncan J Campbell
Med J Aust 2014; 200 (3): . || doi: 10.5694/mja13.10924
Published online: 17 February 2014

To the Editor: In describing an approach to primary prevention of cardiovascular disease (CVD) based on 5-year absolute risk, Nelson and Doust acknowledge that this strategy is unlikely to be tested with a randomised controlled trial.1 Yet there are many examples in medicine where guidelines based on good intentions were subsequently shown to be inappropriate when tested in randomised controlled trials. Caution is required in adopting a formulaic approach to primary prevention of CVD, and there is a need for a greater appreciation of the arbitrary way in which CVD risk is categorised and the lack of precision in its estimation.

  • Department of Molecular Cardiology, St Vincent’s Institute of Medical Research, Melbourne, VIC.


Competing interests:

No relevant disclosures.

  • 1. Nelson MR, Doust JA. Primary prevention of cardiovascular disease: new guidelines, technologies and therapies. Med J Aust 2013; 198: 606-610. <MJA full text>
  • 2. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122: 2748-2764.
  • 3. Lloyd-Jones DM, Leip EP, Larson MG, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006; 113: 791-798.
  • 4. Zomer E, Owen A, Magliano DJ, et al. Validation of two Framingham cardiovascular risk prediction algorithms in an Australian population: the ‘old’ versus the ‘new’ Framingham equation. Eur J Cardiovasc Prev Rehabil 2011; 18: 115-120.
  • 5. Bell K, Hayen A, McGeechan K, et al. Effects of additional blood pressure and lipid measurements on the prediction of cardiovascular risk. Eur J Prev Cardiol 2012; 19: 1474-1485.


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