Will cardiovascular disease prevention widen health inequalities?

The primary prevention of cardiovascular disease (cvd) is dependent on the effective reduction of the major risk factors for cvd,particularly tobacco control and a healthier diet. the high-risk approach to prevent cvd typically involves population screening. those exceeding a risk threshold are then given lifestyle advice and/or tablets to reduce blood cholesterol and blood pressure. evidence suggests this high-risk approach typically widens socioeconomic inequalities. such inequalities have been reported in screening,healthy diet advice,smoking cessation,statin and anti-hypertensive prescribing,and adherence. the alternative approach is population-wide cvd prevention. for example,legislating for smoke-free public spaces,banning dietary transfats,or halving daily dietary salt intake. such strategies are generally effective and cost-saving; there is also increasing evidence that they can reduce health inequalities. we conclude that screening and treating high-risk individuals represents a relatively ineffective cvd prevention approach that typically widens social inequalities. © 2010 capewell,graham.