When to act--the appropriateness of cardiovascular disease intervention

Nearly 13 million people die each year from cardiovascular diseasesand half of these deaths occur in developing countries. Thisarticle reviews the appropriateness of cardiovascular diseaseintervention and focuses on decision-making and the perpetualquestion: When is it more appropriate to act on available evidencerather than to await further evidence? A fundamental and justifiedprinciple in science is trying to falsify all formulated hypotheses.This sceptical or conservative approach can, however, hampersocial development. It is therefore important for the scientistto distinguish between his role as a scientist and as a memberof society. Medical, epidemiological and economic aspects areconsidered together with an assessment of the feasibility ofdifferent intervention strategies. This review, like many others,indicates that population-based interventions combined withan improved high-risk strategy are appropriate from society'spoint of view in spite of the fact that there are several unsettledquestions which call for further research.