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Targeted health checks can better prevent heart attacks and strokes rather than a one size fits all approach

Cardiovascular disease continues to be one of the major killers in the UK. Risk assessment and modification with lifestyle interventions can alter the likelihood of a cardiovascular event and prevent further heart attacks and strokes. We know that the risk of cardiovascular disease is related to age, gender, smoking, blood pressure, diabetes and cholesterol. Interventions such as optimised blood pressure control, a programme of weight control, increased physical activity and statin therapy can all alter future risk and save lives.

How often should this risk assessment take place?

There is some variation in guidelines but overall the general theme is that patients over the age of 40 should have their heart health assessed every five years. However, is this the right timescale for everyone or should risk assessment be tailored to your individual risk? This is an important question and researchers followed 7000 patients in a study published in the Lancet Public Health. Based upon a baseline profile of cardiovascular risk factors, patients were considered to be low risk (10 year cardiovascular risk of <2.5%), intermediate-low (2.5-5%), intermediate high risk (5-7.5%) or high risk (>7.5%). The study found that low risk patients took an average of nine years to reach intermediate-low-risk suggesting that 5 yearly screening is too often in this group. Intermediate-low-risk patients spent an average of seven years in this category and 90% went on to become intermediate-high-risk. However, within 4 years, over two thirds of intermediate-high-risk patients became high-risk and needed treatment.

What would the benefit be of an individualised screening approach?

High-risk patients are told to change their lifestyle, and if that does not work they are offered statins to reduce "bad" cholesterol or drugs to lower blood pressure. The study therefore suggested that low risk patients were being assessed too often and high risk patients were not being seen frequent enough. In a further analysis, the researchers found that screening low-risk patients every seven years, intermediate-low risk every four years and intermediate-high risk every year would be cost neutral compared to the current system. However, this personalised approach would enable high-risk patients to be treated sooner and prevent 8% of heart attacks and strokes. That would prevent 5,000 people a year in England and Wales having a potentially life-threatening heart attack or stroke.

Many people who could benefit from health checks are not getting them in the first place. If you know you're at higher risk of developing heart and circulatory disease, it's really important to attend regular health checks to help manage your risk factors to prevent problems later in life.

Date posted

May 8, 2019