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General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7191 (Published 20 November 2012) Cite this as: BMJ 2012;345:e7191

Re: General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis

Your editorial contains several relevant caveats in assessing the value of periodic health checks. We all know that optimally those at highest risk should be targeted, rather than undertaking blanket checks. However, that is not really the point.

What are the aims of health checks?
1. To diagnose previously undiagnosed medical problems, such as hypertension & diabetes
2. To assess risk of developing future diseases eg CVD
3. To reduce morbidity & mortality of certain diseases
4. To increase life expectancy and quality of life

Achieving morbidity & mortality reductions and increasing life expectancy & improving life quality can only be long-term aims

Appropriate treatment, of newly diagnosed ailments, when indicated, for example in the case of hypertension & diabetes and initiating measures to reduce risk, such as prophylactic statins will assist with achieving these objectives1

However in all cases measures to modify life-style risk factors, such as excessive tobacco & alcohol, obesity, inappropriate diet and inadequate physical activity must be recommended, implemented and monitored to ensure sustained improvement2

Merely performing health checks solely reveals actual or potential problems and in the absence of subsequent measures to treat or reduce the risk of developing ailments is not going to show any beneficial effect on morbidity or mortality.

Does meta-analysis of trials of periodic health checks assess whether following the health check such measures were initiated?

The value, or lack of value, of health checks can only be assessed if studies include details of measures taken to treat or prevent problems highlighted by the check.

1. Taylor F et al. Statins for the primary prevention of CVD Cochrane summaries Published online May 16 2012
2. European Guideline on CVD Prevention in Clinical Practice (version 2012) European Heart Journal 2012 33, 1635-1701

Dr Harald M Lipman
International Cardiac Healthcare & RiskFactor Modification (ICHARM)

Competing interests: Executive Director ICHARM

27 November 2012
Harald M Lipman
Physician
International Cardiac Healthcare & RiskFactor Modification (ICHARM)
The Dutch House 77a Fitzjohn's Avenue London NW3 6NY
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