Home > Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies.

SCORE Investigators. Cooney, Marie-Therese and Dudina, Alexandra and Whincup, Peter and Capewell, Simon and Menotti, Alessandro and Jousilahti, Pekka and Njølstad, Inger and Oganov, Raphel and Thomsen, Troels and Tverdal, Aage and Wedel, Hans and Wilhelmsen, Lars and Graham, Ian (2009) Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies. European Journal of Cardiovascular Prevention & Rehabilitation, 16, (5), pp. 541-549. doi: 10.1097/HJR.0b013e32832b38a1.

BACKGROUND: Options for the prevention of cardiovascular disease, the greatest global cause of death, include population preventive measures (the Rose approach), or specifically seeking out and managing high-risk cases. However, the likely benefit of a population approach has been recently questioned.

OBJECTIVE: To compare the estimated effects of population strategies at varying levels of population-wide risk factor reduction and high-risk strategies at varying rates of screening uptake on cardiovascular disease mortality.

METHODS: Data (of 109 954 participants) were pooled from six European general population cohort studies [the high-risk cohorts from the SCORE (Systematic COronary Risk Evaluation) dataset]. The effects of various population and high-risk strategies for the reduction of risk factors were estimated by calculating the change in 10-year risk of cardiovascular disease mortality (SCORE risk) before and after the particular intervention. Risk factors studied were: total cholesterol, blood pressure and smoking.

RESULTS: At population level, if a 10-year reduction of blood cholesterol level of 10%, a BP reduction of 10% and a 10% reduction in the prevalence of smoking is considered possible, then 9125 lives per million of the population would be saved over 10 years. In contrast, an approach that treats all high-risk individuals with a polypill containing statin, three half-dose antihypertensives and aspirin, with a 20-80% uptake, would save 1861-7452 lives per million. However, the high-risk estimates are very optimistic, as their achievement would require complete compliance.

CONCLUSION: High-risk and population strategies are complementary. These estimates of the benefits of each may be useful to health planners, when combined with their local knowledge. Recently, benefits of population strategies have been underestimated.

Item Type
Publication Type
Irish-related, Article
Drug Type
Tobacco / Nicotine
Intervention Type
Harm reduction
Identification #
doi: 10.1097/HJR.0b013e32832b38a1
Page Range
pp. 541-549
Corporate Creators
SCORE Investigators
Accession Number
HRB (Electronic Only)
Related (external) link

Click here to request a copy of this literature

Repository Staff Only: item control page