A 45-year-old woman has a 10-year cardiovascular disease (CVD) risk calculated at 22% using the WHO/ISH risk prediction chart. According to WHO PEN (Package of Essential NCD Interventions) guidelines, the threshold for initiating pharmacotherapy (statin + antihypertensive) regardless of individual blood pressure or LDL levels is:

• A >10% 10-year CVD risk
• B >20% 10-year CVD risk ✓
• C >30% 10-year CVD risk
• D >40% 10-year CVD risk

Explanation

WHO PEN guidelines recommend initiating statin therapy and antihypertensive therapy for primary prevention when the 10-year CVD risk is ≥20%, regardless of individual risk factor levels (BP or LDL). At risk <10%, lifestyle modification alone is advised; at 10–20%, re-assess in 6–12 months with lifestyle interventions; at ≥20%, pharmacotherapy is recommended. This risk-based approach avoids single risk factor thresholds and is more equitable.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.