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Unanswered questions over NHS health checks

BMJ 2011; 342 doi: (Published 26 January 2011) Cite this as: BMJ 2011;342:c6312
  1. Kamlesh Khunti, professor of primary care diabetes and vascular medicine 1,
  2. Nicola Walker, clinical research fellow1,
  3. Naveed Sattar, professor of metabolic medicine2,
  4. Melanie Davies, professor of diabetes medicine3
  1. 1Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
  2. 2Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
  3. 3Department of Cardiovascular Sciences, University of Leicester
  1. Correspondence to: K Khunti kk22{at}
  • Accepted 3 October 2010

Although plans to offer all adults aged 40-74 in England a regular health check to prevent vascular disease are welcome, Kamlesh Khunti and colleagues point out that success is far from guaranteed

Vascular disease affects more than four million people in England.1 It is responsible for 170 000 deaths a year in England (36% of all deaths) and one fifth of hospital admissions, and it is the largest single cause of long term ill health and disability. To try to reduce the high prevalence and costs, the National Health Service health checks programme for adults aged 40 to 74 years was introduced in England in April 2009, with full implementation planned for 2012-3.

The objective of the programme is to assess risk of developing vascular or metabolic disease (heart attack, angina, stroke, diabetes, and kidney disease) and manage the risk factors to prevent progression and improve outcomes (box 1). These diseases have shared risk factors including smoking, high blood pressure, obesity, physical inactivity, and impaired glucose regulation. An integrated approach to their identification and management is therefore likely to be more cost effective. The Department of Health estimates that if there is universal uptake across the country, the programme could prevent 9500 myocardial infarctions and strokes each year.1 Advocates of these proposals hope that successful implementation may reduce health inequalities in the population by identifying people at risk of disease or with undiagnosed disease earlier. However, many unanswered questions remain.

NHS health checks programme

  • Adults aged 40 to 74 years without a diagnosis of vascular disease will be contacted by their primary care trust and offered a health check

  • Risk assessment includes collection of demographic data, family history, smoking status, cholesterol and blood pressure measurement, and a diabetes filter (figure)

  • An individualised management plan is then developed according to the …

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