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British family heart study: its design and method, and prevalence of cardiovascular risk factors
Insights
A study of British families found significant cardiovascular disease risk factors, including obesity and uncontrolled hypertension, indicating a need for preventative interventions. Further research is needed to confirm the effectiveness of nursing and medical strategies in reducing these risks.
Area of Science:
- Public Health and Epidemiology
- Cardiovascular Disease Prevention
- General Practice Research
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Identifying and managing CVD risk factors in primary care settings is crucial for prevention.
- Systematic screening in general practice can uncover undiagnosed risk factors within families.
Purpose of the Study:
- To determine the prevalence of cardiovascular risk factors in families screened by nurses in British general practices.
- To analyze risk factor prevalence in subgroups with reported hypertension, hypercholesterolemia, diabetes, and coronary heart disease.
- To assess the potential for primary and secondary CVD prevention within a general practice population.
Main Methods:
- A randomized controlled trial involving 26 general practices across England, Wales, and Scotland.
- Systematic family health checks were offered to households with men aged 40-59 and their partners.
- Data collected included screening for hypertension, hypercholesterolemia, diabetes, and existing coronary heart disease.
Main Results:
- Over 57% of invited households participated, with 3850 individuals screened.
- High prevalence of risk factors: 15% in top risk score quintile, 24% of men and 22% of women smoked, 62% of men and 44% of women were overweight.
- Significant rates of uncontrolled hypertension (64%), hypercholesterolemia (over 50% in previously diagnosed), and diabetes (52% in previously diagnosed) were observed.
Conclusions:
- Substantial opportunities exist for primary and secondary prevention of cardiovascular disease in families registered with general practices.
- A high proportion of individuals, particularly those with pre-existing conditions, exhibited modifiable risk factors.
- The efficacy of nursing and medical interventions in reducing cardiovascular disease risk factors in this setting requires further investigation.
Aim:
The aim of this paper is to describe the prevalence of cardiovascular risk factors in families screened systematically by nurses in British general practice, and in subgroups with reported hypertension, hypercholesterolaemia, diabetes and coronary heart disease.
Method:
Twenty six general practices (13 intervention and 13 control practices) in 13 towns in England, Wales and Scotland were involved in a randomized control trial. Randomly ordered invitations were sent for a family health check to 4158 households (men aged 40-59 years and their partners) registered with the 13 intervention practices.
Results:
One or more adult members from 2373 households (57%) were screened; in 1477 visits the selected man and his female partner attended of whom 98% were married. In all, 3850 individuals were screened (2246 men and 1604 women); 15% of men and women were in the predefined top quintile of the British family heart study risk score. Twenty four per cent of men and 22% of women smoked cigarettes and 62% of men and 44% of women were overweight (body mass index 25+). One third of men and one sixth of women with no known history of high blood pressure had a diastolic blood pressure of 90+ mmHg. Among the 491 individuals with previously reported high blood pressure 64% were not adequately controlled, having a diastolic blood pressure of 90+ mmHg, while 26% had diastolic blood pressure of 100+ mmHg. Eighteen per cent of men and women with no known history of a high cholesterol level had a random cholesterol level of 6.5+ mmol l-1. In the 173 people with a previously reported high cholesterol level and who had their level measured over half had a cholesterol level of 6.5+ mmol l-1 and in 7% this level was 8.0+ mmol l-1. One per cent of men and 0.3% of women were newly identified as diabetic (random glucose level of 10.0+ mmol l-1). In the 52 with previously diagnosed diabetes unsatisfactory control was found in 52% (random level of 10.0+ mmol l-1). A total of 3034 men and women overall (79%) qualified for follow up for one or more risk factor; 1909 men (85%) and 1125 women (70%). Among the 139 with pre-existing coronary heart disease 119 (86%) had modifiable risk factors: 27% were cigarette smokers, 68% had a body mass index of 25+, 40% had diastolic hypertension, 29% had hypercholesterolaemia and 19% had hyperglycaemia. Five per cent of men and women were taking antihypertensive drugs, 0.3% cholesterol lowering drugs and 0.7% drugs for diabetes.
Conclusion:
There is considerable scope for primary and secondary prevention among families registered with general practices, but whether nursing and medical intervention can reduce the risk factors related to cardiovascular disease in this setting remains unknown.