New approaches to the implementation of cardiovascular disease prevention

Cardiovascular disease is one of the biggest contemporary health problems worldwide. To aid preventive measures, risk calculators have been developed to estimate the risk of dying of cardiovascular disease within 10 years, for use in healthy individuals. Decisions to initiate preventive measures are based on this risk (primary prevention). The Netherlands and most European countries use SCORE for this purpose. In this thesis, we show that using SCORE leads to a serious underestimation of the total risk of cardiovascular disease when using a broader range of fatal- and non-fatal cardiovascular diseases to estimate this risk. This underestimation is greater in young individuals, and in women more than in men. Therefore, a low risk in young individuals as calculated by SCORE should not necessarily be interpreted as a low risk of developing any (non-fatal) cardiovascular disease. This should be taken into account when advising individuals on primary prevention of cardiovascular disease.
Individuals with cardiovascular disease are at particularly high risk of recurrent events or death, and preventive measures are important to reduce this risk (secondary prevention). In the large RESPONSE trial, we evaluated the effect of a nurse-coordinated prevention programme on improving risk factors in patients with coronary heart disease. The trial demonstrates that the nurse-coordinated prevention programme leads to a significant improvement in risk factors in these patients, thereby reducing the risk of recurrent events. We therefore conclude that all patients with coronary heart disease in the Netherlands should be offered participation in such programs as part of usual care.