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Primary prevention of cardiovascular disease is usually based on individual assessments of risk; people who are likely to develop disease are considered for preventive treatments such as statins. But even those assessed as low risk can have subclinical atheromatous disease. In one study, 984 of 5751 middle aged adults at low risk had clear evidence of thickening in the intima-media of the carotid arteries. When the researchers did a placebo controlled trial of rosuvastatin in these people, two years of active treatment stopped early atherosclerosis from progressing. So should we be screening even low risk adults with carotid ultrasound and treating everyone with early signs of diseasedisease?
Probably not, says a linked editorial (pp 1376-8). At least not yet. While it's clear that low risk doesn't mean “no risk,” we still don't know enough about the link between carotid intima-media thickness and clinical events to go looking for it in everyone. Changes in surrogate markers for cardiovascular and other diseases don't necessarily translate into better health or longer lives.
This study does remind us, however, of the large burden of potential disease lurking in “the vast person time space of the low risk population,” says the editorial. Ambitious and expensive trials that study real clinical events must be done to investigate it properly.