Are we losing the battle against cardiometabolic disease? The case for a paradigm shift in primary prevention

There is a case to be made for a disregard of the difference between statistical significance and clinical relevance of the reported data. Nevertheless, lifestyle change remains the main weapon in our battle against the epidemic of cardiometabolic disease. But along the way from risk screening to intervention to maintenance the compound inefficiencies of current primary preventive strategies marginalize their impact.Unless we dramatically change the ways in which we deploy preventive interventions we will inevitably lose the battle. In this paper we will argue for three provocative strategy changes, namely (a) the disbanding of screening in favor of population-wide enrollment into preventive interventions, (b) the substitution of the current cost utility analysis for a return-on-investment centered appraisal of interventions, and (c) the replacement of standardized programs modeled around acute care by individualized and perpetual interventions.Chronic cardiometabolic disease has become a prominent public health concern chiefly for a unique combination of three prospects:a) pandemic and costly: its constituent diseases lead in the mortality statistics [1-3] and in the top 10 ranks of the most costly diseases [4].b) predictable: aberrant vital parameters identify at-risk individualsc) preventable: lifestyle change prevents disease in at-risk individualsWhile the first observation is incontestable, the second and third are not. In the following we will challenge some of the notions on which our prevention strategies have been based. We will provide evidence to the fact that our current prevention efforts are inadequate to yield a significant reduction of the epidemic of cardiometabolic diseases. We will argue that our current prevention strategies fail to achieve their objective for three reasons:1. inefficiencies of screening2. inefficiencies of intervention3. inappropriate economic principlesFrom the discussion of these three aspects we will (a) propose a statistica