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Meta-Analysis
. 2016 Jan 29;2016(1):CD010411.
doi: 10.1002/14651858.CD010411.pub2.

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease

Mariana Dyakova  1 , Saran Shantikumar, Jill L Colquitt, Christian M Drew, Morag Sime, Joanna MacIver, Nicola Wright, Aileen Clarke, Karen Rees
Affiliations
Meta-Analysis

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease

Mariana Dyakova et al. Cochrane Database Syst Rev. .

Abstract

Background: Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings.

Objectives: The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30 January 2015, and Web of Science Core Collection and additional databases on the Cochrane Library on 4 December 2014. We also searched two clinical trial registers and checked reference lists of relevant articles. We applied no language restrictions.

Selection criteria: We selected randomised controlled trials (RCTs) that assessed the effects of systematic risk assessment, defined as a screening-like programme involving a predetermined selection process of people, compared with opportunistic risk assessment which ranged from no risk assessment at all to incentivised case finding of CVD and related risk factors. Participants included healthy adults from the general population, including those who are at risk of CVD.

Data collection and analysis: Two review authors independently selected studies. One review author extracted data and assessed them for risk of bias and a second checked them. We assessed evidence quality using the GRADE approach and present this in a 'Summary of findings' table.

Main results: Nine completed RCTs met the inclusion criteria, of which four were cluster-randomised. We also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. The length of follow-up varied from one year in four studies, three years in one study, five or six years in two studies, and ten years in two studies. Eight studies recruited participants from the general population, although there were differences in the age ranges targeted. One study recruited family members of cardiac patients (high risk assessment). There were considerable differences between the studies in the interventions received by the intervention and control groups. There was insufficient evidence to stratify by the types of risk assessment approaches.Limited data were available on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.92 to 1.02; 3 studies,103,571 participants, I² = 0%; low-quality evidence) and cardiovascular mortality (RR 1.00, 95% CI 0.90 to 1.11; 2 studies, 43,955 participants, I² = 0%), and suggest that screening has no effect on these outcomes. Data were also limited for combined non-fatal endpoints; overall, evidence indicates no difference in total coronary heart disease (RR 1.01, 95% CI 0.95 to 1.07; 4 studies, 5 comparisons, 110,168 participants, I² = 0%; low-quality evidence), non-fatal coronary heart disease (RR 0.98, 95% CI 0.89 to 1.09; 2 studies, 43,955 participants, I² = 39%), total stroke (RR 0.99, 95% CI 0.90 to 1.10; 2 studies, 79,631 participants, I² = 0%, low-quality evidence), and non-fatal stroke (RR 1.17, 95% CI 0.94 to 1.47; 1 study, 20,015 participants).Overall, systematic risk assessment appears to result in lower total cholesterol levels (mean difference (MD) -0.11 mmol/l, 95% CI -0.17 to -0.04, 6 studies, 7 comparisons, 12,591 participants, I² = 57%; very low-quality evidence), lower systolic blood pressure (MD -3.05 mmHg, 95% CI -4.84 to -1.25, 6 studies, 7 comparisons, 12,591 participants, I² = 82%; very low-quality evidence) and lower diastolic blood pressure (MD -1.34 mmHg, 95% CI -1.76 to -0.93, 6 studies, 7 comparisons, 12,591 participants, I² = 0%; low-quality evidence). One study assessed adverse effects and found no difference in psychological distress at five years (1126 participants).

Authors' conclusions: The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow-up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 1 All‐cause mortality.
1.3
1.3. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 3 Cardiovascular mortality.
1.4
1.4. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 4 Mortality due to stroke.
1.5
1.5. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 5 Stroke (total).
1.6
1.6. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 6 Coronary heart disease (total).
1.7
1.7. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 7 Non‐fatal coronary heart disease.
1.8
1.8. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 8 Non‐fatal stroke.
1.9
1.9. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 9 Total cholesterol, mmol/l.
1.10
1.10. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 10 HDL cholesterol, mmol/l.
1.11
1.11. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 11 LDL cholesterol, mmol/l.
1.12
1.12. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 12 Triglycerides, mmol/l.
1.13
1.13. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 13 Systolic blood pressure, mmHg.
1.14
1.14. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 14 Diastolic blood pressure, mmHg.
1.15
1.15. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 15 Number with elevated cholesterol.
1.16
1.16. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 16 Number with elevated SBP.
1.17
1.17. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 17 Number with elevated DBP.
1.18
1.18. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 18 Number with diabetes.
1.19
1.19. Analysis
Comparison 1 Systematic screening vs no/opportunistic screening, Outcome 19 Number with elevated cardiovascular risk score.
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Update of

  • doi: 10.1002/14651858.CD010411

References

References to studies included in this review

BFHS 1994 {published data only}
    1. Family Heart Study Group. British Family Heart Study: its design and method, and prevalence of cardiovascular risk factors. British Journal of General Practice 1994;44(379):62‐7. - PMC - PubMed
    1. Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British Family Heart Study. BMJ 1994;308(6924):313‐20. - PMC - PubMed
    1. Marteau TM, Kinmonth AL, Thompson S, Pyke S. The psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group. The British Journal of General Practice 1996;46(411):577‐82. - PMC - PubMed
    1. Wonderling D, McDermott C, Buxton M, Kinmonth AL, Pyke S, Thompson S, et al. Costs and cost effectiveness of cardiovascular screening and intervention: the British Family Heart Study. BMJ 1996;312(7041):1269‐73. - PMC - PubMed
BFHS Men {published data only}
    1. Family Heart Study Group. British Family Heart Study: its design and method, and prevalence of cardiovascular risk factors. British Journal of General Practice 1994;44(379):62‐7. - PMC - PubMed
    1. Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British Family Heart Study. BMJ 1994;308(6924):313‐20. - PMC - PubMed
    1. Marteau TM, Kinmonth AL, Thompson S, Pyke S. The psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group. The British Journal of General Practice 1996;46(411):577‐82. - PMC - PubMed
    1. Wonderling D, McDermott C, Buxton M, Kinmonth AL, Pyke S, Thompson S, et al. Costs and cost effectiveness of cardiovascular screening and intervention: the British Family Heart Study. BMJ 1996;312(7041):1269‐73. - PMC - PubMed
BFHS Women {published data only}
    1. Family Heart Study Group. British Family Heart Study: its design and method, and prevalence of cardiovascular risk factors. British Journal of General Practice 1994;44(379):62‐7. - PMC - PubMed
    1. Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British Family Heart Study. BMJ 1994;308(6924):313‐20. - PMC - PubMed
    1. Marteau TM, Kinmonth AL, Thompson S, Pyke S. he psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group. The British Journal of General Practice 1996;46(411):577‐82. - PMC - PubMed
    1. Wonderling D, McDermott C, Buxton M, Kinmonth AL, Pyke S, Thompson S, et al. Costs and cost effectiveness of cardiovascular screening and intervention: the British Family Heart Study. BMJ 1996;312(7041):1269‐73. - PMC - PubMed
CHAPS 2011 {published data only}
    1. Kaczorowski J, Chambers LW, Dolovich L, Paterson JM, Karwalajtys T, Gierman T, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ 2011;342:d442. - PMC - PubMed
    1. Kaczorowski J, Chambers LW, Karwalajtys T, Dolovich L, Farrell B, McDonough B, et al. Cardiovascular Health Awareness Program (CHAP): a community cluster‐randomised trial among elderly Canadians. Preventive Medicine 2008;46(6):537‐44. - PubMed
EHPP 2002 {published data only}
    1. Christensen B, Engberg M, Lauritzen T. No long‐term psychological reaction to information about increased risk of coronary heart disease in general practice. European Journal of Cardiovascular Prevention and Rehabilitation 2004;11(3):239‐43. - PubMed
    1. Engberg M, Christensen B, Karlsmose B, Lous J, Lauritzen T. General health screenings to improve cardiovascular risk profiles: a randomized controlled trial in general practice with 5‐year follow‐up. Journal of Family Practice 2002;51(6):546‐52. - PubMed
    1. Kanstrup H, Refsgaard J, Engberg M, Lassen JF, Larsen ML, Lauritzen T. Cholesterol reduction following health screening in general practice. Scandinavian Journal of Primary Health Care 2002;20(4):219‐23. - PubMed
    1. Lauritzen T, Jensen MS, Thomsen JL, Christensen B, Engberg M. Health tests and health consultations reduced cardiovascular risk without psychological strain, increased healthcare utilization or increased costs. An overview of the results from a 5‐year randomized trial in primary care. The Ebeltoft Health Promotion Project (EHPP). Scandinavian Journal of Public Health 2008;36(6):650‐61. - PubMed
    1. Lauritzen T, Leboeuf‐Yde C, Lunde IM, Nielsen KDB. Ebeltoft project: Baseline data from a five‐year randomized, controlled, prospective health promotion study in a Danish population. British Journal of General Practice 1995;45(399):542‐7. - PMC - PubMed
FIT Heart 2008 {published data only}
    1. Mosca L, Mochari H, Liao M, Christian AH, Edelman DJ, Aggarwal B, et al. A novel family‐based intervention trial to improve heart health: FIT Heart: results of a randomized controlled trial. Circulation. Cardiovascular Quality and Outcomes 2008;1(2):98‐106. - PMC - PubMed
Inter99 2014 {published data only}
    1. Jørgensen T, Jacobsen RK, Toft U, Aadahl M, Glümer C, Pisinger C. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ 2014;348:g3617. [DOI: 10.1136/bmj.g3617] - DOI - PMC - PubMed
Murray 1986 {published data only}
    1. Murray DM, Luepker RV, Pirie PL, Grimm RH, Bloom E, Davis MA, et al. Systematic risk factor screening and education: a community‐wide approach to prevention of coronary heart disease. Preventative Medicine 1986;15(6):661‐72. - PubMed
OXCHECK 1995 {published data only}
    1. Imperial Cancer Research Fund Oxcheck Study Group. Prevalence of risk factors for heart disease in the Oxcheck trial: implications for screening in primary care. BMJ 1991;301(6784):1057‐60. - PMC - PubMed
    1. Imperial Cancer Research Fund Oxcheck Study Group. The effectiveness of health checks conducted by nurses in primary care: Final results from the Oxcheck study. BMJ 1995;310(6987):1099‐104. - PMC - PubMed
    1. Langham S, Thorogood M, Normand C, Muir J, Jones L, Fowler G. Costs and cost effectiveness of health checks conducted by nurses in primary care: the Oxcheck study. BMJ 1996;312(7041):1265‐8. - PMC - PubMed
WHO 1986 {published data only}
    1. World Health Organization European Collaborative Group. European collaborative trial of multifactorial prevention of coronary heart disease: final report on the 6‐year results. Lancet 1986;327(8486):869‐72. - PubMed
    1. World Health Organization European Collaborative Group. Multifactorial trial in the prevention of coronary heart disease: 1. Recruitment and initial findings. European Heart Journal 1980;1(1):73‐80. - PubMed
    1. World Health Organization European Collaborative Group. Multifactorial trial in the prevention of coronary heart disease: 3. Incidence and mortality results. European Heart Journal 1983;4:141‐47. - PubMed
Wilhelmsen 1986 {published data only}
    1. Wilhelmsen L, Berglund G, Elmfeldt D, Tibblin G, Wedel H, Pennert K, et al. The multifactor primary prevention trial in Goteborg, Sweden. European Heart Journal 1986;7(4):279‐88. - PubMed

References to studies excluded from this review

Boylan 2003 {published data only}
    1. Boylan MJ, Renier CM, Knuths JS, Haller IV. Preventing cardiovascular disease in women: an intervention‐control randomized study. Minnesota Medicine 2003;86(5):52‐6. - PubMed
Göteborg 1963 {published data only}
    1. Tibblin G, Welin L, Larsson B, Ljungberg IL, Svärdsudd K. The influence of repeated health examinations on mortality in a prospective cohort study, with a comment on the autopsy frequency. The study of men born in 1913. Scandinavian Journal of Social Medicine 1982;10(1):27‐32. - PubMed
Grunfeld 2013 {published data only}
    1. Grunfeld E, Manca D, Moineddin R, Thorpe KE, Hoch JS, Campbell‐Scherer D, et al. Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial. BMC Family Practice 2013;14:175. - PMC - PubMed
Holt 2010 {published data only}
    1. Holt TA, Thorogood M, Griffiths F, Munday S, Friede T, Stables D. Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial. British Journal of General Practice 2010;60(573):e137‐43. - PMC - PubMed
Jacobson 2006 {published data only}
    1. Jacobson TA, Gutkin SW, Harper CR. Effects of a global risk educational tool on primary coronary prevention: the Atherosclerosis Assessment Via Total Risk (AVIATOR) study. Current Medical Research and Opinion 2006;22(6):1065‐73. - PubMed
Kaiser Permanente 1965 {published data only}
    1. Friedman GD, Collen MF, Fireman BH. Multiphasic Health Checkup Evaluation: a 16‐year follow‐up. Journal of Chronic Diseases 1986;39(6):453‐63. - PubMed
Koelewijn‐van Loon 2010 {published data only}
    1. Koelewijn‐van Loon MS, Weijden T, Ronda G, Steenkiste B, Winkens B, Elwyn G, et al. Improving lifestyle and risk perception through patient involvement in nurse‐led cardiovascular risk management: a cluster‐randomized controlled trial in primary care. Preventive Medicine 2010;50(1‐2):35‐44. - PubMed
Malmö 1969 {published data only}
    1. Lannerstad O, Sternby NH, Isacsson SO, Lindgren G, Lindell SE. Effects of a health screening on mortality and causes of death in middle‐aged men. A prospective study from 1970 to 1974 of mean in Malmö, born 1914. Scandinavian Journal of Social Medicine 1977;5(3):137‐40. - PubMed
New York 1971 {published data only}
    1. Shapiro S. Evaluation of two contrasting types of screening programs. Preventive Medicine 1973;2(2):266‐77. - PubMed
Northumberland 1969 {published data only}
    1. Bennett AE, Fraser IG. Impact of a screening programme in general practice: a randomized controlled trial. International Journal of Epidemiology 1972;1(1):55‐60. - PubMed
Ogedegbe 2014 {published data only}
    1. Ogedegbe G, Plange‐Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, et al. A cluster‐randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implementation Science 2014;9:10. - PMC - PubMed
Salt Lake City 1972 {published data only}
    1. Olsen DM, Kane RL, Proctor PH. A controlled trial of multiphasic screening. New England Journal of Medicine 1976;294(17):925‐30. - PubMed
South‐East London 1967 {published data only}
    1. The South‐East London Study Group. A controlled trial of multiphasic screening in middle‐age: results of the South‐East London screening study. International Journal of Epidemiology 1977;6(4):357–63. - PubMed
Stockholm 1969 {published data only}
    1. Theobald H, Bygren LO, Carstensen J, Hauffman M, Engfeldt P. Effects of an assessment of needs for medical and social services on long‐term mortality: a randomized controlled study. International Journal of Epidemiology 1998;27(2):194–8. - PubMed
Titograd 1971 {published data only}
    1. Thorner RM, Djordjevic D, Vuckmanovic C, Pesic B, Culafic B, Mark F. A study to evaluate the effectiveness of multiphasic screening in Yugoslavia. Preventive Medicine 1973;2(2):295–301. - PubMed
Vagholkar 2014 {published data only}
    1. Vagholkar S, Zwar N, Jayasinghe UW, Denney‐Wilson E, Patel A, Campbell T, et al. Influence of cardiovascular absolute risk assessment on prescribing of antihypertensive and lipid‐lowering medications: A cluster randomized controlled trial. American Heart Journal 2014;167(1):28‐35. - PubMed
Voogdt‐Pruis 2010 {published data only}
    1. Voogdt‐Pruis HR, Beusmans GH, Gorgels AP, Kester AD, Ree JW. Effectiveness of nurse‐delivered cardiovascular risk management in primary care: a randomised trial. British Journal of General Practice 2010;60(570):40‐6. - PMC - PubMed

References to ongoing studies

Badenbroek 2014 {published data only}
    1. Badenbroek IF, Stol DM, Nielen MMJ, Hollander M, Kraaijenhagen RA, Wit GA, et al. Design of the INTEGRATE study: effectiveness and cost‐effectiveness of a cardiometabolic risk assessment and treatment program integrated in primary care. BMC Family Practice 2014;15:90. - PMC - PubMed
Ijkema 2014 {published data only}
    1. Ijkema R, Aerde MA, Aalst CM, Ballegooijen M, Oudkerk M, Koning HJ. A randomized controlled trial measuring the effectiveness of screening for cardiovascular disease using classic risk assessment and coronary artery calcium: The ROBINSCA study. European Journal of Preventive Cardiology 2014;May:S21.
Marshall 2012 {published data only}
    1. Marshall T, Caley M, Hemming K, Gill P, Gale N, Jolly K. Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedged cluster RCT. BMC Public Health 2012;12:908. - PMC - PubMed
Muntendam 2012 {published data only}
    1. Muntendam P, McCall C, Sanz J, Falk E, Fuster V. The BioImage Study: Novel approaches to risk assessment in the primary prevention of atherosclerotic cardiovascular disease‐study design and objectives. American Heart Journal 2010;160(1):49‐57. - PubMed
Wan 2009 {published data only}
    1. Wan Q, Harris MF, Zwar N, Campbell T, Patel A, Vagholkar S, et al. Study protocol for a randomized controlled trial: The feasibility and impact of cardiovascular absolute risk assessment in Australian general practice. American Heart Journal 2009;157(3):436‐41. - PubMed

Additional references

Bernard 2009
    1. Bernard SL, Lux L, Lohr KN (RTI International). QQUIPP: Healthcare Delivery Models for Prevention of Cardiovascular Disease (CVD). London: The Health Foundation, 2009.
Beswick 2008
    1. Beswick AD, Brindle P, Fahey T, Ebrahim S. A Systematic Review of Risk Scoring Methods and Clinical Decision Aids Used in the Primary Prevention of Coronary Heart Disease (Supplement). NICE Clinical Guidelines No. 67S. London: Royal College of General Practitioners, 2008 (available from www.ncbi.nlm.nih.gov/books/NBK55818/). - PubMed
BHF 2012a
    1. British Heart Foundation. Cardiovascular disease. www.bhf.org.uk/heart‐health/conditions/cardiovascular‐disease.aspx (accessed 30 August 2012).
BHF 2012b
    1. British Heart Foundation. Our heart disease facts. www.bhf.org.uk/media/news‐from‐the‐bhf/bhf‐facts.aspx (accessed 29 March 2012).
Chamnan 2010
    1. Chamnan P, Simmons R, Khaw K, Wareham N, Griffin S. Estimating the population impact of screening strategies for identifying and treating people at high risk of cardiovascular disease: modelling study. BMJ 2010;340:c1693. - PMC - PubMed
CONSORT 2012
    1. Altman DG, Moher D, Schultz KF. Improving the reporting of randomised trials: The CONSORT statement and beyond. Statistics in Medicine 2012;31(25):2985‐97. - PubMed
Cooney 2009
    1. Cooney MT, Dudina A, Winchup P, Capewell S, Menotti A, Jousilahti P, et al. SCORE Investigators. Re‐evaluating the Rose approach: comparative benefits of the population and high‐risk preventive strategies. European Journal of Cardiovascular Prevention and Rehabilitation 2009;16(5):541–9. - PubMed
DH 2000
    1. Department of Health. National Service Framework for Coronary Heart Disease. London: Stationery Office, 2000.
DH 2008a
    1. Department of Health. Putting Prevention First. Vascular Checks: Risk Assessment and Management. Impact Assessment. London: Department of Health, 2008.
DH 2008b
    1. Department of Health. Economic Modelling for Vascular Checks. London: Department of Health, 2008.
DH 2013
    1. Department of Health. Cardiovascular Disease Outcomes Strategy. Improving outcomes for people with or at risk of cardiovascular disease 2013. www.gov.uk/government/uploads/system/uploads/attachment_data/file/217118... (accessed 22 March 2015).
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Every contact counts 2012
    1. Every contact counts. Every contact counts. Raising health consciousness using brief interventions. www.everycontactcounts.co.uk/ (accessed 3 August 2012).
GBD 2013
    1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age–sex specific all‐cause and cause‐specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study. Lancet 2013;385(9963):117‐71. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Jackson 2008
    1. Jackson R, Wells S, Rodgers A. Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes. BMJ 2008;337:a1371. - PubMed
Krogsbøll 2012
    1. Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD009009.pub2] - DOI - PubMed
Lawson 2010
    1. Lawson K, Fenwick E, Pell ACH, Pell J. Comparison of mass and targeted screening strategies for cardiovascular risk: simulation of the effectiveness, cost‐effectiveness and coverage using a cross‐sectional survey of 3921 people. Heart 2010;96(3):208‐12. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
NHS 2012
    1. NHS. Health check. www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheck.aspx (accessed 2 September 2012).
NICE 2016
    1. National Institute for Health and Care Excellence (NICE). The NICE Indicator Menu for the QOF. https://www.nice.org.uk/standards‐and‐indicators/qofindicators (accessed 29th January 2016).
NPSA 2007
    1. National Patient Safety Agency, NHS. Healthcare Risk Assessment Made Easy. (available from www.nrls.npsa.nhs.uk/resources/?EntryId45=59825). London: NPSA, 2007.
O'Flaherty 2009
    1. O’Flaherty M, Bishop J, Redpath A, McLaughlin T, Murphy D, Chalmers J, et al. Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study. BMJ 2009;339:b2613. - PMC - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rose 2008
    1. Commentary by Khaw KT, Marmot M. Rose’s Strategy of Preventive Medicine. The Complete Original Text. Oxford: Oxford University Press, 2008.
Short 2009
    1. Short R. Putting Vascular Disease Management into Practice. Bath: Medical Management Services, 2009.
Tunstall‐Pedoe 2003
    1. Tunstall‐Pedoe H (editor). MONICA Monograph and Multimedia Sourcebook. World's Largest Study of Heart Disease, Stroke, Risk Factors and Population Trends 1979–2002. Geneva: WHO, 2003.
UKNSC 2008
    1. UK National Screening Committee. The Handbook for Vascular Risk Assessment, Risk Reduction and Risk Management. Leicester: University of Leicester, 2008.
WHO 2002
    1. World Health Organization. Integrated Management of Cardiovascular Risk. Report of a WHO meeting, Geneva, 9‐12 July 2002. Geneva: WHO, 2002.
WHO 2007
    1. World Health Organization. Prevention of Cardiovascular Disease. Guidelines for Assessment and Management of Cardiovascular Risk. Geneva: WHO, 2007.
WHO 2011a
    1. World Health Organization. Media centre: cardiovascular diseases (CVDs). www.who.int/mediacentre/factsheets/fs317/en/index.html (accessed 29 March 2012).
WHO 2011b
    1. World Health Organization. Noncommunicable diseases and mental health. www.who.int/nmh/countries/en/index.html (accessed 26 June 2012).
WHO 2013
    1. World Health Organization. The European Health Report 2012: Charting the Way to Well‐being. www.euro.who.int/en/publications/abstracts/european‐health‐report‐2012 (accessed 20 March 2015).
WHO 2014a
    1. World Health Organization. Global Status Report on Noncommunicable Diseases 2014. www.who.int/nmh/publications/ncd‐status‐report‐2014/en/ (accessed 6 April 2015). - PubMed
WHO 2014b
    1. World Health Organization. World Health Statistics 2014. www.who.int/gho/publications/world_health_statistics/2014/en/ (accessed 6 April 2015).
Wood 1994
    1. Wood D, Kinmonth A, Davies G, Yarwood J, Thompson S, Pyke S, et al. Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British family heart study. BMJ 1994;308(6924):313‐20. - PMC - PubMed
Yusuf 2004
    1. Yusuf S, Hawken S, Ôunpuu T, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. The Lancet 2004;364(9438):937‐52. - PubMed

References to other published versions of this review

Dyakova 2013
    1. Dyakova M, Drew C, Wright N, Clarke A, Rees K. Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD010411] - DOI - PMC - PubMed

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