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

doi:10.1136/bmj.a1395

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Simon Capewell, professor of clinical epidemiology

¹University of Liverpool, Liverpool L69 3GB

capewell{at}liverpool.ac.uk

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

Evidence supporting the high risk approach for preventing cardiovascular disease is disappointing. The strategy has low effectiveness and is associated with high cost, residual risk, medicalisation, and increasing inequalities. Whole population approaches are cheaper and more effective.

Low effectiveness

The large OXCHECK trial (of a nurse led health check plus health education and follow-up tailored to the level of cardiovascular risk) had only modest effects on cardiovascular events.1 Indeed, more recent literature raises further concerns.2 3 Healthcare professionals’ advice to stop smoking or take more exercise also 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 common in the more deprived groups, who also experience higher rates of …