Conclusions
The analyses presented in this chapter indicate that providing off-patent blood pressure and cholesterol-lowering medications targeted at those at high absolute risk seems to be a cost-effective strategy. Currently available personal interventions to prevent or reduce high BMI are likely to be much less cost-effective.
An approach based on absolute risk will still involve choosing some level below which people are not recommended for personal treatments, which will leave some people at risk of progression of vascular disease. This issue exists with current paradigms and underscores the need for parallel improvements in population-based prevention. The strategy based on absolute risk must be regarded as complementary to populationwide initiatives that address the root causes of CVD—in particular, the societal determinants that lead to high salt and saturated fat in the diet in relation to high blood pressure and cholesterol and high-energy diets coupled with decreasing physical activity in relation to high bodyweight. Preventing and reducing those risks in developing countries will reduce the need for medication-based prevention strategies in the coming decades.
