Testing for cardiovascular disease risk factors doubles in patients who go to an NHS Health Check
Patients who have NHS Health Checks are more than twice as likely to have cardiovascular risk factors – such as blood pressure and cholesterol – measured by their GP, according to a study by King’s College London.
The study, published in the Journal of Public Health, also found NHS Health Checks were linked with reduced gender and socioeconomic inequality in testing, and with slightly higher prescribing of statins.
The NHS Health Check programme was introduced in 2010 and provides free cardiovascular risk checks for 40- to 74-year-olds every 5 years to identify risk factors for heart disease, stroke, dementia, kidney disease and diabetes.
The study analysed anonymised GP health records from 75,123 UK patients who underwent NHS Health Checks and 182,245 matched controls who did not complete a health check. Patients who already had diabetes, heart disease or stroke were excluded from the study.
The biggest gains were seen in cholesterol testing, with only 43% of patients who had not attended a health check having cholesterol recorded, compared with 92% of health check patients. Overall, the proportion of people with all four main cardiovascular risk factors - smoking status, BMI, cholesterol and blood pressure - recorded increased from 40% to 91% after health checks.
There was a small increase in statin prescriptions, from 7.6% in the controls to 11% in those who had health checks.
The health checks reduced inequalities, as males of lower socioeconomic status who had health checks were more likely to have their risk factors tested similarly to men of higher socioeconomic status. However, there was no reduction for inequality seen for women.
Fewer NHS Health Check participants said that they smoked – only 19% reported smoking, compared with 25% of the controls - and the study authors suggested this could be because smokers may be less inclined to attend health checks, or tell their GP that they smoke at a health check.
Professor Martin Gulliford, senior author from the Division of Health and Social Care Research at King’s College London, said: ‘The Health Checks programme has been quite controversial as there is not yet evidence that these checks will produce health benefits. We have evaluated how NHS Health Checks are being implemented and found they lead to increased testing for cholesterol, blood pressure and obesity and some reductions in inequalities. There has also been recent controversy about statin prescribing in patients without established disease, but this study suggests that GPs are not rushing to prescribe statins after Health Checks.’
Dr Alice Forster, lead author from the Division of Health and Social Care Research at King’s College London (and now based at UCL), said: ‘The greater detection of cardiovascular disease risk factors in people who go for an NHS Health Check means at risk people can be monitored, make lifestyle changes or, if appropriate, receive treatments to prevent cardiovascular disease. While our findings can tell us that NHS Health Checks are detecting the risk factors for cardiovascular disease, they cannot tell us whether this will lead to a reduction in the number of people with cardiovascular disease or deaths from related illnesses, such as stroke, heart disease or diabetes. Long term follow-up will be needed to understand whether the NHS Health Checks reduce cardiovascular disease.’
Frances Fuller, study author and Public Health Strategist for the London Borough of Lewisham said: ‘The results of this study are encouraging and indicate that the NHS Health Check programme may be effective at identifying individuals at increased risk. Based on these early findings, health checks have the potential to reduce the number of people dying from strokes, heart attacks, diabetes and dementia by identifying those at highest risk. Health Checks are still relatively new and longer term studies will be needed to understand the full impact of the programme.’
The authors also caution that the control group could have included people who had declined a health check, who might also be more likely to decline to do tests at their GP normally.
‘Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records’ by Forster et al is published in the Journal of Public Health.
For more information, please contact Hilary Jones, Communications Manager for the Division of Health and Social Care Research at King’s College London on tel: +44 (0)20 7848 6684, email: email@example.com.
This research was supported by Guy’s and St. Thomas’ Charity (grant number: G100702).