British family heart study: its design and method, and prevalence of cardiovascular risk factors

Abstract

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.