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Cardiovascular Disease Prevention and the NHS Reforms

Since the late 1980s, there have been major reforms of the British National Health Service, including the setting up of an internal market for health care, a new GP contract, and the development of a health strategy. This paper describes these reforms and discusses their impact on the prevention of cardiovascular disease. There has been an increased emphasis on identifying and treating individuals at high risk of cardiovascular disease in general practice, but randomised controlled trials suggest that this will have only a limited impact on cardiovascular mortality. In contrast to this ‘high risk’ approach, population based approaches aimed at reducing the levels of risk factors in the whole population depend to a greater extent on the involvement of organisations outside the health service. Such approaches take time to develop, and it is premature to judge the impact of the reforms on such initiatives.