Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme

Dalton, Andrew; Soljak, Michael; Samarasundera, Edgar; Millett, Christopher; Majeed, Azeem

doi:10.1177/1741826711428797

Cited by 34 publications

(24 citation statements)

References 17 publications

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“…First and foremost, although there are well-recognized management strategies for prevention of stroke, transient ischemic attack, and other NCDs, 30 these strategies are primarily targeted at high-risk individuals that represent a small proportion of those who will go on to have a stroke. 31,32 Given that the majority of strokes in the population occur in those with mildly elevated stroke risk, population-wide reduction strategies aimed at all levels of stroke risk would improve the effectiveness of these campaigns. In addition, clinical experience shows that an unintended consequence of risk assessment is that people who are told by a doctor they are at low (<5%) and moderate (5% to 14%) 5-year risk of CVD occurrence are not motivated enough to do anything to control their risk factors because they think they are not at high risk of CVD.…”

Section: Strokementioning

confidence: 99%

New Strategy to Reduce the Global Burden of Stroke

Feigin

Krishnamurthi

Bhattacharjee

et al. 2015

Stroke

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The socioeconomic and health effect of stroke and other noncommunicable disorders (NCDs) that share many of the same risk factors with stroke, such as heart attack, dementia, and diabetes mellitus, is huge and increasing. [1][2][3][4] Collectively, NCDs account for 34.5 million deaths (66% of deaths from all causes) 3 and 1344 million disability-adjusted life years lost worldwide in 2010. 2 The burden of NCDs is likely to burgeon given the aging of the world's population and the epidemiological transition currently observed in many low-to middle-income countries (LMICs). 5,6 In addition, there is low awareness in the population about these NCDs and their risk factors, 7-10 particularly in LMICs.11 These factors, coupled with underuse of strategies for primary prevention of stroke/NCDs on an individual level and the lack of accurate data on the prevalence and effect of risk factors in different countries and populations have been implicated in the ever-increasing worldwide burden of the NCDs. [12][13][14][15] Of particular concern is a significant increase in the number of young adults (aged <65 years) affected by stroke, 16 and the increasing epidemic of overweight/obesity 17 and diabetes mellitus worldwide. 18 If these trends continue, the burden of stroke and other major NCDs will increase even faster. The increasing burden of stroke and other major NCDs provide strong support for the notion that the currently used primary prevention strategies for stroke and other major NCDs (business as usual) are not sufficiently effective. The most pertinent solution to this problem is the implementation of new, effective, widely available, and cost-effective prevention and treatment strategies to reduce the incidence and severity distribution of stroke and other major NCDs. Issues With Population-Wide Prevention StrategiesThe recent INTERSTROKE case-control study, conducted in 22 countries worldwide, provided evidence that, collectively, 10 risk factors accounted for 88.1% (99% confidence interval, 82.3%-92.2%) of the population-attributable risk for all stroke. 19 Because many (but not all) of these risk factors are modifiable, the INTERSTROKE data suggest that interventions that reduce blood pressure, promote physical activity, smoking cessation, and a healthy diet, could substantially reduce the burden of stroke. Although a combination of population-wide and individual high-risk prevention strategies were initially advocated >30 years ago, 20 and have since been repeatedly recommended as the most promising strategies to reduce stroke and NCDs burden, there is still no country in the world where both these prevention strategies have been implemented in full. There are major hurdles to implementing population-wide primary prevention strategies, including the need for policy and legislative changes that are often not supported by major industries (such as salt reduction in processed food, reduction of exposure to cigarette smoking, alcohol, and fast food). In addition, there are significant costs associated with the imple...

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Section: Strokementioning

confidence: 99%

New Strategy to Reduce the Global Burden of Stroke

Feigin

Krishnamurthi

Bhattacharjee

et al. 2015

Stroke

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“…We used the direct method of standardisation, using eight equal-age groups and the complete dataset as the standard. We applied the QRISK2 13 (after the 2010 update) and JBS2 10 risk scores to each imputed copy of the data set, calculating the mean score across imputations for each patient, for each method of imputation. We summarised levels of the two risk scores and differences overall in each sex/ethnicity group, and the proportion designated as at high risk ( 20%) -using direct age standardisation.…”

Section: Discussionmentioning

confidence: 99%

The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

Dalton

Bottle²,

Soljak³

et al. 2011

Journal of Innovation in Health Informatics

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Background Targeted screening for cardiovascular disease (CVD) can be carried out using existing data from patient medical records. However, electronic medical records in UK general practice contain missing risk factor data for which values must be estimated to produce risk scores. Objective To compare two methods of substituting missing risk factor data; multiple imputation and the use of default National Health Survey values. Methods We took patient-level data from patients in 70 general practices in Ealing, North West London. We substituted missing risk factor data using the two methods, applied two risk scores (QRISK2 and JBS2) to the data and assessed differences between methods. Results Using multiple imputation, mean CVD risk scores were similar to those using default

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confidence: 99%

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confidence: 99%

“…Indeed, approximately 80% of strokes occur in people categorised as having low absolute risk. 4 Therefore, in communicating absolute CVD risk, categorization of people into low, moderate (mild) and high risk should be abandoned.5 (3) Management of blood pressure: The current absolute CVD high-risk strategy approach is based on overall CVD risk. Thus, individuals with blood pressures (BP) higher than 140/90 mmHg, which conventionally defines hypertension, may not be treated with antihypertensive medication because of a five-year absolute CVD risk below 15%.…”

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Primary stroke prevention needs overhaul

Feigin

2016

International Journal of Stroke

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There is compelling evidence from the Global Burden of Disease (GBD) Study that the burden of stroke and cardiovascular disease (CVD) has been increasing fast over the last two and half decades. These deficiencies are further highlighted by significant gender and ethnic disparities, and a trend towards more strokes in younger people. This suggests very strongly that currently used primary stroke and CVD prevention measures, which include high-risk (screening of the population for absolute CVD risk) and population-wide strategies, are not sufficiently effective. Identifying the causes of the failure in primary stroke and CVD prevention on individual and population levels and the most promising strategies to improve the situation is the first step in combating these leading causes of disease burden in the world. KeywordsEpidemiology, global burden, prevention, primary prevention, risk-o-meter, stroke There are several important gaps in primary stroke prevention.(1) Lack of awareness: Despite the evidence for modifying health behaviour, 1 the level of public awareness of stroke, its risk factors, and management is low. 2This means that behaviour modification is suboptimal and can (and should) be greatly enhanced, (2) False reassurance of low risk and lack of motivation: Current primary prevention strategies recommendations primarily target people with moderate to high absolute CVD risk.3 Individuals labeled as 'low risk' are falsely reassured and not motivated to reduce their risk, despite many having several modifiable risk factors. Indeed, approximately 80% of strokes occur in people categorised as having low absolute risk. 4 Therefore, in communicating absolute CVD risk, categorization of people into low, moderate (mild) and high risk should be abandoned.5 (3) Management of blood pressure: The current absolute CVD high-risk strategy approach is based on overall CVD risk. Thus, individuals with blood pressures (BP) higher than 140/90 mmHg, which conventionally defines hypertension, may not be treated with antihypertensive medication because of a five-year absolute CVD risk below 15%. 6 However, high BP is an important modifiable risk factor and has been identified as a leading cause of stroke burden worldwide, and therefore should be addressed appropriately.7 (4) Important stroke risk factors missed from screening: With the exception of smoking, behavioural risk factors such as poor diet, sedentary lifestyle, overweight and excessive alcohol intake are not usually included in the stroke/CVD risk algorithms that are currently used. This is despite the fact that nearly three quarters of the global burden of stroke is linked to lifestyle choices. 7 (5) Low specificity of the CVD prediction algorithms: Most of the currently used CVD prediction algorithms are based on the Framingham study of a primarily white population of North America; therefore, such algorithms may not be applicable to other populations (e.g. Black, Asian, Arabian, Spanish, etc.). (6) Cost barrier in high-risk strategies: Seeing a physician...

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Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme

Cited by 34 publications

References 17 publications

New Strategy to Reduce the Global Burden of Stroke

New Strategy to Reduce the Global Burden of Stroke

The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

Primary stroke prevention needs overhaul

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