Heart 2014;100:ii1-ii67 doi:10.1136/heartjnl-2014-305693
• Review
Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

1. British Cardiovascular Society, Association of British Clinical Diabetologists, British Association for Cardiovascular Prevention & Rehabilitation, British Association for Nursing in Cardiovascular Care, British Heart Foundation, British Hypertension Society, British Renal Society, Diabetes UK, HEART UK, Renal Association, Stroke Association

Foreword
In 1961, the publication of the findings of the Framingham study provided the National Institutes of Health (NIH), the USA, and the world at large with a huge return on the initial investment. Identification of the common risk factors fuelling the epidemic of cardiovascular disease (CVD) stimulated a ‘call to arms’ and the initiation of programmes to attack these targets on a national scale.

This has led to stunning declines in CVD mortality over the last 40–50 years in North America, Western Europe and other high income countries.

Nonetheless, this is not the time for complacency. CVD is by far and away the leading cause of deaths worldwide; the epidemic of CVD in the low and middle income countries is rampant and the alarming increases in obesity and diabetes threaten to reverse or blunt the steady decline in CVD mortality, particularly in younger people. The focus on prevention is as imperative now as it ever has been.

This is the 3rd iteration of the Joint British Societies ( JBS) recommendations for the prevention of cardiovascular disease. Current prevention strategies tend to focus upon patients at relatively short term (10-year) risks and upon specific thresholds for pharmacologic therapies, although there is considerable variability among the different guidelines. This approach is logical and has been successful in directing therapy to those at highest risk who stand to gain the greatest benefit.

A unique aspect of JBS3 is the emphasis upon the lifetime risk of CVD events, so as to encompass a large pool of people in the population who have a lower 10-year risk of a CVD event but who nevertheless have a high lifetime event risk.
Such predominantly younger patients and women might be excluded from therapy based upon the ‘high risk strategy’, even though they have a high rate of significantly elevated and modifiable risk factors. Recognition of this ‘continuum of risk’, and the impact of the duration of exposure to risk factors upon future CVD events, is an important concept and offers the opportunity to modify the evolution of CVD.

This consensus statement is clearly written, evidence based, and beautifully illustrated. The JBS3 risk calculator is a novel and exciting tool that can be used to motivate both physicians and patients to tackle the potential scourge of CVD, at a time when overt disease is not present and prevention may exert its greatest impact.

The importance of these consensus recommendations and this document will extend beyond the boundaries of the UK and provides an invaluable resource for all physicians and healthcare providers who are involved in the prevention of CVD.

Bernard J Gersh
Professor of Medicine, and Consultant, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine.

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