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Healthy people should be screened for risk of getting heart disease. It is not clear how best to screen people.

Khanji MY, Bicalho VV, van Waardhuizen CN, et al. Cardiovascular Risk Assessment: A Systematic Review of Guidelines. Ann Intern Med. 2016;165:713-22.

Review question

What do guidelines say about whether and how to screen healthy people for risk of getting heart (cardiovascular) disease?

Background

People with heart disease (e.g., coronary artery disease [which causes angina and heart attacks] or heart rhythm problems [such as atrial fibrillation]) often have symptoms that reduce their quality of life. They may die prematurely from heart attacks, strokes, or other related conditions. Clinical guidelines provide recommendations for patient care based on research evidence. Recommendations from guidelines about heart disease may help doctors and health care organizations identify people who are at risk for developing the disease. Heart disease may be prevented or delayed if people who are at risk can be identified early.

How the review was done

The researchers did a systematic review, searching for guidelines published in English between May 2009 and June 2016. They found 17 national or international guidelines that were well done.

The guidelines:

  • were developed in Australia, Canada, Europe, New Zealand, the UK, or the USA;
  • focused on screening generally healthy adults; and
  • recommended how to assess the risks for people getting heart disease or a condition related to heart disease (e.g., abnormal blood glucose or fat levels, or high blood pressure [hypertension]).

What the researchers found

Most guidelines recommended:

  • screening generally healthy people for risk of getting heart disease;
  • using prediction models to identify who is most at risk for getting heart disease;
  • repeating screening every so often; and
  • using interventions in some people to prevent heart disease.

Guidelines did not agree on:

  • which people should be screened (e.g., what age to start screening);
  • which prediction models were best;
  • how often repeat screening should be done; or
  • when to use preventive interventions.

Conclusions

Healthy people should be screened for risk of getting heart disease. Guidelines have different recommendations about when and how to screen people.

Guideline recommendations for screening generally healthy people for risk of getting heart disease or a condition related to heart disease

Recommendations

Special considerations

Generally healthy people should be screened for risk of getting heart disease (16 guidelines).

Guidelines had different criteria for deciding which healthy people to screen (e.g., age to start screening).

Screening can be done at regular patient health care visits (14 of 17 guidelines).

 

Risk prediction models should be used to estimate each person’s level of risk (14 guidelines).

Different guidelines recommended different risk prediction models.

All risk prediction models included several risk factors, and most included age, sex, ethnicity, smoking status, blood pressure, and cholesterol levels.

Risk levels can be used to identify people who need further screening or treatment.

People should be rescreened every so often (11 guidelines).

The recommended frequency of rescreening varied across guidelines.

Most general guidelines recommended rescreening every 2 to 6 years in people at low risk.

Interventions to prevent heart disease (e.g., aspirin, cholesterol-lowering drugs, blood pressure-lowering drugs, lifestyle changes) may be considered for some people (14 guidelines).

Guidelines had different criteria for deciding when people should start preventive interventions.

 




Glossary

Angina
Chest pain due to reduced blood flow to the heart.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

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