Prevention of atherosclerotic cardiovascular disease: Why are the benefits of lifestyle therapies neglected?

There are two approaches for reducing atherosclerotic cardiovascular disease (ASCVD): the population approach and the clinical strategy. The population approach attempts to lower risk in the whole population through promotion of healthy life habits. The clinical strategy is an extension of the population approach; it employs the same principles as the public health approach, but applied to patients at high enough risk for ASCVD to justify long-term risk reduction through clinical management. The population approach has provided consistent messages on cardiovascular risk reduction for over four decades. They emphasize avoidance or cessation of cigarette smoking, reduction of intakes of saturated fats and cholesterol, achieving and maintaining a healthy body weight, regular physical activity, and regular medical checkups for ASCVD risk factors. The use of regular medical checkups is vital for linking the population and clinical approaches. Unfortunately, the current health care system is lacking in clinical preventive strategies. However, if the overall strategy for ASCVD risk reduction is to be successful, this component will have to be strengthened greatly.