The National Screening Committee has recommended a paradigm of informed choice for participants in all screening programmes. Theresa Marteau and Ann Louise Kinmonth examine the potential consequences of applying such a policy to screening for risk of coronary heart disease in primary care

Current recommendations for the primary prevention of coronary heart disease in groups at high risk depend on screening through primary care and provision of risk related advice or treatment.1 Criticisms of these recommendations highlight the lack of evidence for the cost effectiveness of multiple risk factor interventions delivered through primary care. 2 3 We propose that this lack of effectiveness may, in part, reflect how people are invited for screening. The public health approach most often used focuses on maximising participation in screening rather than on informed participation. We consider here the implications of offering primary preventive services for cardiovascular disease within a framework of informed choice.