Targeted checks could prevent one in 10 heart attacks
25 April 2019
Nearly one in 10 heart attacks and strokes in England and Wales could be prevented if routine check-ups were better targeted, according to a study by UCL and the University of Helsinki.
Currently, people aged 40 and over are eligible to have an assessment of their cardiovascular disease risk every five years. The health check looks at a variety of risk factors, including systolic blood pressure, cholesterol profile, blood glucose, and smoking status. High-risk patients are advised to change their lifestyle, and if that is not sufficient they may be offered statins or drugs to lower blood pressure.
But researchers at UCL and the University of Helsinki found that these five-year checks meant low-risk patients were being seen too frequently and high-risk patients were not being checked often enough.
They estimated that if the frequency of check-ups was tailored to an individual’s level of risk, about 5,000 heart attacks and strokes would be prevented each year in England and Wales.
The researchers found that this would be achieved without any increased health care costs.
Currently, a five-year interval is recommended in guidelines by the American Heart Association and the European Society of Cardiology, but these five-yearly screenings are not based on direct research evidence.
The study, published in Lancet Public Health, followed over 7,000 men and women to see how their cardiovascular disease risk developed over 22 years.
It found that "low-risk" patients took an average of nine years to reach "intermediate-low-risk", while "intermediate-low-risk" patients stayed in this category for an average of seven years. But within four years, 70% of "intermediate-high-risk" patients became "high-risk" and needed treatment.
The researchers then simulated different systems of screening people depending on their level of risk. They concluded that screening low-risk patients every seven years, intermediate-low every four years and intermediate-high every year cost the same as the current system.
Professor Mika Kivimaki (UCL Institute of Epidemiology & Health Care), senior author of the study, said: "The key message is to use individualised screening, not one-size-fits-all.
“An individualised screening interval would enable more effective cardiovascular disease prevention by means of lifestyle intervention or preventive medication, because of more timely detection of those at high risk.
“The results show that simple changes in primary care can make a difference."
“Our findings are promising, but national guidelines are rarely changed based on one study. The benefits of individualised screening intervals should be further studied in a randomised control trial before changing the guidelines,” Professor Kivimaki added.
UK residents can determine their individual cardiovascular disease risk with the QRISK3 calculator, which includes questions about age, sex, smoking, total cholesterol, HDL-cholesterol, systolic blood pressure, antihypertensive medication, diabetes status, and a variety of medical conditions. The calculator is freely available from https://qrisk.org/three.
The study was funded by the Medical Research Council, British Heart Association, National Institutes on Aging, NordForsk, Academy of Finland.
- Full paper in The Lancet Public Health
- Professor Mika Kivimaki’s academic profile
- UCL Institute of Epidemiology & Health Care
- UCL Population Health Sciences
- University of Helsinki
- Academy of Finland
- Medical Research Council
- British Heart Association
- National Institutes on Aging
Tel: +44 (0)20 3108 9485
Email: m.greaves [at] ucl.ac.uk