Will screening individuals at high risk of cardiovascular events deliver large benefits? No

doi:10.1136/bmj.a1395

Published 28 August 2008, doi:10.1136/bmj.a1395
Cite this as: BMJ 2008;337:a1395

Head to Head

Will screening individuals at high risk of cardiovascular events deliver large benefits? No

Simon Capewell, professor of clinical epidemiology

¹ University of Liverpool, Liverpool L69 3GB

capewell@liverpool.ac.uk

The Department of Health is planning to identify and treat alladults over 40 at high risk of a cardiovascular event. Rod Jacksonand colleagues (doi: 10.1136/bmj.a1371) argue that a well targetedprogramme will save many lives, but Simon Capewell thinks wholepopulation approaches would be more cost effective

The first 150 words of the full text of this article appear below.

Evidence supporting the high risk approach for preventing cardiovasculardisease is disappointing. The strategy has low effectivenessand is associated with high cost, residual risk, medicalisation,and increasing inequalities. Whole population approaches arecheaper and more effective.

The large OXCHECK trial (of a nurse led health check plus healtheducation and follow-up tailored to the level of cardiovascularrisk) had only modest effects on cardiovascular events.¹ Indeed,more recent literature raises further concerns.² ³ Healthcareprofessionals’ advice to stop smoking or take more exercisealso has frustratingly modest effects.⁴

All screening programmes are imperfect. Even with generous resources,the call, recall, and follow-up systems require major commitments.Drop outs are substantial. Screening failures will be more commonin the more deprived groups, who also experience higher ratesof disease, thus increasing inequalities.⁵ ⁶

All cardiovascular risk scoring systems are inaccurate and potentiallyconfusing. Even the best risk charts have predictive accuracyof . . . [Full text of this article]

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

A plea for broader perspectives on health: Fiona Godlee
BMJ 2008 337: a1923. [Extract] [Full Text]

Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes: Rod Jackson, Sue Wells, and Anthony Rodgers
BMJ 2008 337: a1371. [Extract] [Full Text]

Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories: Bernard Vrijens, Gäbor Vincze, Paulus Kristanto, John Urquhart, and Michel Burnier
BMJ 2008 336: 1114-1117. [Abstract] [Full Text] [PDF]

Revisiting Rose: strategies for reducing coronary heart disease: Douglas G Manuel, Jenny Lim, Peter Tanuseputro, Geoffrey M Anderson, David A Alter, Andreas Laupacis, and Cameron A Mustard
BMJ 2006 332: 659-662. [Full Text] [PDF]

Effectiveness of health checks conducted by nurses in primary care: final results of the OXCHECK study
BMJ 1995 310: 1099-1104. [Abstract] [Full Text]

This article has been cited by other articles:

Jontell, M., Glick, M. (2009). Oral Health Care Professionals' Identification of Cardiovascular Disease Risk Among Patients in Private Dental Offices in Sweden. Journal of the American Dental Association 140: 1385-1391 [Abstract] [Full text]

Rapid Responses:

Read all Rapid Responses

Why Fight 20th Century Battles?: Michael A Soljak
bmj.com, 29 Aug 2008 [Full text]
Whose battle are we fighting, anyway?: Hegde BM
bmj.com, 9 Sep 2008 [Full text]
Are treatments of those identified by screening really the best?: Raymond G Holder
bmj.com, 10 Sep 2008 [Full text]
Targeting, community, and a top down aporach is needed to improve health: David J Kinshuck
bmj.com, 7 Oct 2008 [Full text]
Reduction of incidence of Cardiovascular disease: Harald M Lipman
bmj.com, 8 Oct 2008 [Full text]
Screening for Original Sin: J. david leopold
bmj.com, 9 Oct 2008 [Full text]