General health checks may workBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4697 (Published 30 July 2014) Cite this as: BMJ 2014;349:g4697
- Torsten Lauritzen, professor1,
- Annelli Sandbaek, professor1,
- Knut Borch-Johnsen, chief operating officer2
- 1Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
- 2Holbæk Hospital, Holbæk, Denmark
We disagree with Gøtzsche and colleagues’ conclusion that general health checks don’t work,1 which is based on their Cochrane review and the recent Inter99 publication.2 The Cochrane review included older trials and thus tested outdated screening tests and treatments. A recent meta-analysis of general practice based health checks found small improvements in surrogate outcomes, especially in high risk patients.3 The Inter99 study was based on lifestyle counselling only and did not include drug treatments.2 It was a hospital based study with a low participation rate (39-52%).
By contrast, modelling studies indicate that screening for diabetes and cardiovascular risk is cost effective. The Anglo-Danish-Dutch study of intensive treatment of people with screen detected diabetes in primary care found a 17% non-significant reduction in first cardiovascular event for intensive treatment versus routine care. The lack of a significant difference may be due to high treatment quality in the routine care group. A retrospective analysis found no significant difference in seven year all cause mortality in people thought to be at highest cardiovascular risk at screening (HbA1c ≥48 mmol/mol) versus those with normal glucose tolerance at screening. All cause mortality was twice as high in people thought to be at lowest cardiovascular risk (HbA1c <42 mmol/mol at screening). A likely explanation for this paradox is that GPs were falsely reassured by low HbA1c values and did not offer these patients full preventive interventions.4
In contrast to Gøtzsche and colleagues, we find that general practice health checks for diabetes and cardiovascular risk may work. Future studies might help us improve health checks by providing information on screening strategies, treatment intensity, and how to maximise attendance rates and adherence. Meanwhile GPs should still offer opportunistic screening for people at high risk of diabetes and cardiovascular disease.2 5
Cite this as: BMJ 2014;349:g4697
Competing interests: TL has shares in Novo Nordisk.
Full response at: www.bmj.com/content/348/bmj.g3680/rr/759594.