**Author details**

matched well with the needs of individuals, probably resulting in better motivation and compliance to medications or behaviour change [42]. However, the benefits of the highrisk approach are limited to a minority of the population. Further, a high-risk strategy demands that individuals change eating, smoking and physical activity habits that may be largely shaped and constrained by social norms (e.g. to eat differently from family and friends), and may thus be seen as 'behaviourally inappropriate'. As this approach does not seek to address the underlying causes of health problems in the population, it is only palliative and temporary [43]. The high-risk approach was described by Geoffrey Rose as 'no more than an expensive rescue operation, offering disappointingly little towards solving the overall problem', so it cannot be the sole means for prevention of cardiovascular

Given compelling evidence that more cases of cardiovascular disease arise from a larger number of people at low risk than the smaller number of people at high risk, it might be more beneficial to shift the whole distribution of risk factors, such as body mass index, cholesterol or blood glucose, in the population in a favourable direction (population-based strategy). This phenomenon is commonly observed for diseases where the association of the disease with risk factors is linear or curvilinear, while the population distribution of these risk factors is approximately normal. For example, Emberson et al. demonstrated that small reductions in the population distribution of cardiovascular risk factors (total cholesterol and systolic blood pressure) might prevent similar or more CVD events than a strategy focusing preventive efforts on those at highest risk [44]. Therefore, in addition to a high-risk approach, there may be an important role for a 'population-based approach' to shift the population distribution of

In practice, balanced implementation of the high-risk and population-based approaches for CVD prevention is likely to be necessary [2]. Within resource-constrained health service systems in developing countries, the high-risk preventive strategies, which focus efforts on those at highest risk, may be seen as a feasible and cost-effective means of prevention. However, complementary population-based preventive strategies are also needed to address the cause

In conclusion, CVD risk stratification in developing countries will assure that limited resource be allocated to individuals or groups who need it most. In developing countries, the clear rationale for cardiovascular risk assessment is crucial. The main rationale for cardiovascular risk assessment includes ranking individuals according to absolute cardiovascular risk for the purpose of targeting therapy to those at greatest risk, providing prognostic information or accurate estimation of the likely benefits from preventive/therapeutic interventions, and motivating individuals to change their behaviours and adhere to treatments. As not many developing countries have adopted this approach, a number of issues need to be addressed, including development of population-specific risk scores, recalibration of available risk scores and uncertainty over cost-effectiveness of CVD risk assessment in developing countries. Although this high-risk approach appears to be effective and practical for developing countries, a complementary population-based approach is needed to maximize benefits for CVD

disease [42].

66 Recent Trends in Cardiovascular Risks

CVD risk factors.

prevention.

of the disease incidence in the population.

Parinya Chamnan1 \* and Wichai Aekplakorn<sup>2</sup>

\*Address all correspondence to: parinya.chamnan@cardiomet-res.org

1 Cardiometabolic Research Group, Department of Social Medicine, Sanpasitthiprasong Hospital,Ubon Ratchathani, Thailand

2 Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

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