General health screenings to improve cardiovascular risk profiles: A randomized controlled trial in general practice with 5-year follow-up

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Original Research

General health screenings to improve cardiovascular risk profiles: A randomized controlled trial in general practice with 5-year follow-up

J Fam Pract. 2002 June;51(6):546-552

By

Marianne Engberg, MD, PhD

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References

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ABSTRACT

OBJECTIVES: To investigate the impact of general health screenings and discussions with general practitioners on the cardiovascular risk profile of a random population of patients.

STUDY DESIGN: A population-based, randomized, controlled, 5-year follow-up trial conducted in a primary care setting.

POPULATION: The study group consisted of 2000 patients, randomly selected middle-aged men and women aged 30 to 50 years, from family practices in the district of Ebeltoft, Denmark. Of these patients, 1507 (75.4%) agreed to participate. Patients were randomized into (1) a control group that received no health screenings, (2) an intervention group that received 2 health screenings, (3) an intervention group that received both the 2 screenings and a 45-minute follow-up consultation annually.

OUTCOMES MEASURED: Cardiovascular risk score (CRS), body mass index (BMI), blood pressure, serum cholesterol, carbon monoxide in expiratory air, and tobacco use.

RESULTS: After 5 years, the CRS, BMI, and serum cholesterol levels were lower in the intervention groups compared with the control group. The improved outcome was greater in the baseline risk groups. The number of patients with elevated CRS in the intervention groups was approximately half the number of patients with elevated CRS in the control group. The difference was not a result of medication use. There was no difference between the group that received consultations after the screenings and the group that had health screenings alone.

CONCLUSIONS: Health screenings reduced the CRS in the intervention groups. After 5 years of follow-up, the number of persons at elevated cardiovascular risk was about half that expected, based on the prevalence/proportion in a population not receiving the health checks (the control group). The impact of intervention was higher among at-risk individuals. Consultations about health did not appear to improve the cardiovascular profile of the study population.

KEY POINTS FOR CLINICIANS

Health screening decreased cardiovascular risk in the general population.
The mean cardiovascular risk score was modestly reduced, and the proportion of persons at elevated cardiovascular risk was reduced to about half that expected after 5 years.
The impact was more marked among groups at risk for cardiovascular disease.
Planned health discussions in relation to the health screening did not seem to increase the impact on cardiovascular risk profile.

Many general practitioners believe their patients benefit from preventive health care and, as a result, many concentrate on identifying and treating risk factors for coronary heart disease (CHD),^1,2 as many studies show that intervention can reduce risk.^3-6 Other studies have suggested that such intervention results in only modest improvements in the risk profile of the general population,^7-12 which raises questions about the efficacy of preventive health care.^13,16 As of the early 1990s, few randomized, controlled, long-term trials have documented the effect of health screening as a primary prevention tool in reducing cardiovascular risk in the general population.^17,18 In earlier large-scale studies on multiple-riskfactor intervention, interventions were not restricted to the intervention groups (controls received similar interventions to some extent); moreover, the studies contained other methodological problems that may have minimized the outcomes between control and intervention groups.^19-21

This study was inspired by a Danish trial²² that focused not only on the prevention of CHD, but on preventing general health problems using lifestyle changes as the primary intervention tool.²³ During the 1990s, results from 2 studies using different, though comparable, randomized designs were published.^7-10 These studies focused more narrowly on the prevention of CHD^8,17,18 and only 1 study had follow-up of more than 1 year. Relevant studies of the impact of intervention, therefore, are still lacking.

This article reports on the impact of general health screenings and health discussions with general practitioners on the cardiovascular risk profile of an unrandomized population. Other aspects of the study have been reported elsewhere.^24-32

Methods

Setting and participants

The study took place in the district of Ebeltoft, Aarhus County, Denmark, a rural area with a total population of approximately 13,000. All 9 general practitioners from the district participated. Before the study began, the general practitioners participated in 4 meetings on prevention of heart and lung disease, dietary advice, and engaging in health discussions with patients.

Of 3464 inhabitants aged 30 to 49 years by January 1, 1991, and registered with a local general practitioner, a random sample of 2000 (57.7%) were invited to participate in the study. An employee of Aarhus County who was not otherwise involved in the study selected participants by birth dates. Registration with a general practitioner gives free access to medical services and is available to all Danish citizens. The 3464 persons from whom the participants were drawn constituted 87% of the entire population in the selected age group.