Screening for coronary heart disease risk among men in a general practice

This study evaluates the effectiveness of screening men for coronary heart disease (CHD) risk during a general practice health screening programme.

Patients age 30-69 years were recruited by opportunistic invitation over 3 years into the screening programme. A self administered questionnaire was used to identify personal and family history of CHD, stroke or diabetes, smoking and alcohol use, and exercise history. Blood pressure, weight and height were recorded by the practice nurse, and laboratory measurement of serum cholesterol and fasting glucose (family history of diabetes or obese patients) arranged. CHD risk status was assessed by the doctor.

Increased CHD risk was assessed in 24% (68) of the 284 men screened (28 high risk, 40 moderate risk). The prevalence of diagnosed hypertension increased from 11% to 18%. Serum cholesterol > 7.5 mmol/L was found in 8% (23 men), though nearly all the 68 men at increased risk would have been identified without routine cholesterol measurement. A 24% smoking cessation rate was reported among the 41 smokers in the increased risk group, with a 56% cessation rate among those at highest risk attending for regular follow up. The prevalence of an alcohol use disorder among those in the increased risk group was 34% compared with 13% among all men in this practice age group.

A high screening rate was achieved by opportunistic recruitment into the screening programme with more complete assessment of CHD risk status than achieved by the previous opportunistic approach. Sufficient new findings justified the effort involved in screening. Continuing surveillance was identified as an important requirement for successful risk reduction.