Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter Two. Review of effective interventions

A focus on overall risk

Overall risk refers to the probability of disease onset over a specified time period. Cut points for defining individuals at high risk and requiring clinical intervention need to be based on consideration of the desires of informed patients, the availability of cost-effective interventions and the risks and benefits of interventions, as well as their cost. Ideally, the assessment of future risk should be based on locally relevant data; unfortunately this is not usually available and risks are often assessed on the basis of data from other populations.

The overall risk of new cardiovascular disease events can be estimated by taking into account several risk factors. The charts on the following pages make it simple to calculate a person's risk. These charts estimate the risk of a cardiovascular event per 100 people over the next five years among people without previous symptomatic cardiovascular disease. They are used by identifying the category relating to a person's sex, diabetic status, tobacco-use history and age.

Interventions for high-risk individuals

There are several highly effective clinical interventions appropriate for individuals at high risk. The benefits of the intervention must, however, clearly outweigh any danger, such as unwanted pharmacological effects. Interventions should be evidence-based, and they should also consider local needs and resource constraints. Sufficient resources must be available to provide the intervention to all those identified as in need.