Letters

Health checks and coronary risk

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7036.974a (Published 13 April 1996) Cite this as: BMJ 1996;312:974

Effect of health checks was underplayed

  1. Jeffrey Graham
  1. Honorary consultant in public health medicine Department of Public Health, Barnet Health Agency, Colindale Hospital, London NW9 5HG

    EDITOR,—P Hanlon and colleagues unduly underplay the results of their randomised controlled trial of health checks to reduce the risk of coronary heart disease.1 In fact, the outcome is remarkably good: it is not a “small effect.”

    A 10% reduction in serum cholesterol concentration reduces the risk of coronary heart disease by 54% at age 40, falling to 20% at age 70.2 In the study the concentration fell by 2.2% (from a baseline value of 5.88 mmol/l) to give a 9.6% fall in the risk of coronary heart disease, assuming that the age distribution of the intervention group was the same as that of the total study population. This is not bad for a single health promotion session. Of course, to have its full effect the observed reduction must be sustained. Again, there are grounds for optimism. A three year follow up in the broadly similar OXCHECK study showed that improvements in health behaviour were maintained over this period, even without annual follow up.3

    There are not enough data in Hanlon and colleagues' paper for estimation of the cost effectiveness of their intervention. In a broadly similar trial (the family heart study), however, the risk of coronary heart disease fell by about 12% in one year and the risk of stroke fell by 10%, as judged from the observed reduction in blood pressure.4 If such an intervention is begun at age 40 and benefit continues until age 59 without further support, the cost would be pounds sterling360 per life year saved—an exceptional bargain. Providing periodic follow up would increase costs; annual follow up (six monthly for the 40% of patients at highest risk) would increase the cost per life year saved to pounds sterling1500, which would still be good value. By comparison, coronary artery bypass grafting for severe angina costs pounds sterling2000-5000 per quality adjusted life year saved.

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