title: Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care A comparison between participants and non-participants in a primary preventive trial. British family heart study: its design and method, and prevalence of cardiovascular risk factors. General health screenings to improve cardiovascular risk profiles: a randomized controlled trial in general practice with 5-year follow-up. Life style intervention in general practice: Effects on psychological well-being and patient satisfaction Effect of screening for Type 2 diabetes on population-level self-rated health outcomes and measures of cardiovascular risk: 13-year follow-up of the Ely cohort A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial You can't prevent everything anyway: a qualitative study of beliefs and attitudes about refusing health screening in general practice. Effect of population screening for type 2 diabetes on mortality: long-term follow-up of the Ely cohort A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. 1977. Effects of an assessment of needs for medical and social services on long-term mortality: a randomized controlled study. No long-term psychological reaction to information about increased risk of coronary heart disease in general practice The Influence of Repeated Health Examinations on Mortality in a Prospective Cohort Study, with a Comment on the Autopsy Frequence: The Study of Men Born in 1913 Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial Systematic risk factor screening and education: a community-wide approach to prevention of coronary heart disease.
abstract: Background Treatment goals for cardiovascular risk management are generally not achieved . Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid . The aim of this study was to compare st and ard treatment supported by self-monitoring with st and ard treatment without self-monitoring , both conducted by practice nurses , on cardiovascular risk and separate risk factors . Methods Men aged 50–75 years and women aged 55–75 years without a history of cardiovascular disease or diabetes , but with a SCORE 10-year risk of cardiovascular mortality ≥5 % and at least one treatable risk factor ( smoking , hypertension , lack of physical activity or overweight ) , were r and omized into two groups . The control group received st and ard treatment according to guidelines , the intervention group additionally received pro-active counseling and self-monitoring ( pedometer , weighing scale and / or blood pressure device ) . After one year treatment effect on 179 participants was analyzed . Results SCORE risk assessment decreased 1.6 % ( 95 % CI 1.0–2.2 ) for the control group and 1.8 % ( 1.2–2.4 ) for the intervention group , difference between groups was .2 % ( −.6–1.1 ) . Most risk factors tended to improve in both groups . The number of visits was higher and visits took more time in the intervention group ( 4.9 ( SD2.2 ) vs. 2.6 ( SD1.5 ) visits p < .001 and 27 ( P25 –P75:20–33 ) vs. 23 ( P25 –P75:19–30 ) minutes/visit p = .048 ) . Conclusions In both groups cardiovascular risk decreased significantly after one year of treatment by practice nurses . No additional effect of basing the pro-active counseling on self-monitoring was found , despite the extra time investment . Trial registration trialregister.nl Abstract The drop-out problem was studied in a r and omly selected population sample of men invited to a primary preventive trial against coronary heart disease among middle-aged men . Participants and non- participants in the intervention group were compared with regard to mortality , causes of death , autopsy findings , morbidity and sobriety . The non-participation group was characterized by a somewhat higher prevalence of chronic diseases and alcoholic problems . These features were more pronounced in subjects who died during the follow-up compared to still living subjects . Mortality , total as well as cause-specific , was considerably higher among non- participants . The death rate was higher in the non-participation group irrespective of duration of sick leave . The amount of coronary atherosclerosis , evaluated post-mortem , was essentially the same in those who died in the participation and non-participation groups . The difference in characteristics between participants and non- participants affects the possibilities of generalization to the total population under study . Similar differences between participants and non- participants are certainly present in other studies too AIM The aim of this paper is to describe the prevalence of cardiovascular risk factors in families screened systematic ally by nurses in British general practice , and in subgroups with reported hypertension , hypercholesterolaemia , diabetes and coronary heart disease . METHOD Twenty six general practice s ( 13 intervention and 13 control practice s ) in 13 towns in Engl and , Wales and Scotl and were involved in a r and omized control trial . R and omly 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 practice s. 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 r and om 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 ( r and om glucose level of 10.0 + mmol l-1 ) . In the 52 with previously diagnosed diabetes unsatisfactory control was found in 52 % ( r and om 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 practice s , but whether nursing and medical intervention can reduce the risk factors related to cardiovascular disease in this setting remains unknown OBJECTIVES To investigate the impact of general health screenings and discussion s with general practitioners on the cardiovascular risk profile of a r and om population of patients . STUDY DESIGN A population -based , r and omized , controlled , 5-year follow-up trial conducted in a primary care setting . POPULATION The study group consisted of 2000 patients , r and omly selected middle-aged men and women aged 30 to 50 years from family practice s in the district of Ebeltoft , Denmark . Of these patients , 1507 ( 75.4 % ) agreed to participate . Patients were r and omized into ( 1 ) a control group who did not receive health screenings , ( 2 ) an intervention group that received 2 health screenings , ( 3 ) an intervention group that received both the 2 screenings and a 45-minute follow-up consultation annually with their general practitioner . OUTCOMES MEASURED Cardiovascular risk score ( CRS ) , body mass index ( BMI ) , blood pressure , serum cholesterol , carbon monoxide in expiratory air , and tobacco use . RESULTS After 5 years , the CRS , BMI , and serum cholesterol levels were lower in the intervention groups compared with the control group . The improved outcome was greater in the baseline risk groups . The number of patients with elevated CRS in the intervention groups was approximately half the number of patients with elevated CRS in the control group . The difference was not a result of medication use . There was no difference between the group that received consultations after the screenings and the group that had health screenings alone . CONCLUSIONS Health screenings reduced the CRS in the intervention groups . After 5 years of follow-up , the number of persons at elevated cardiovascular risk was about half that expected , based on the prevalence/proportion in a population not receiving the health checks ( the control group ) . The impact of intervention was higher among at-risk individuals . Consultations about health did not appear to improve the cardiovascular profile of the study population The objectives of this study were to : ( 1 ) study if an opportunistic screening of coronary heart disease ( CHD ) risk factors among male attenders in general practice ( GP ) influenced the overall subjective satisfaction with life of persons labelled ‘ high risk ’ compared to other screened persons ; ( 2 ) compare psychological well-being and patient satisfaction in a patient centred and self-directive ( PCSD ) intervention with conventional care ( CC ) ; and ( 3 ) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study . Effects of ‘ labelling ’ were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population . The 22 participating GP centres were r and omly allocated to follow either a PCSD intervention or a CC approach . An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Question naire ( 20 item version ) . Satisfaction measures on health care aspects were also included . No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening . No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention . Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group ( p=0.02 ) . Satisfaction with own efforts for improving health was , however , more pronounced in the PCSD group ( p=0.01 ) . A substantial number ( n=61 ) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health . Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected , clinicians should be aware that encouraging patients to change life style may lead to patients ' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts . Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts , but reduce satisfaction with medical care Aims There is continuing uncertainty regarding the overall net benefits of population -based screening for Type 2 diabetes . We compared clinical measures , prescribed medication , cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population . Methods A parallel-group , cohort study of people aged 40–65 years , free of known diabetes , identified from the population register of a general practice in Ely , Cambridgeshire ( n = 4936 ) . In 1990–1992 , one third ( n = 1705 ) , selected r and omly , received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals ( screened population ) . From the remainder of the sampling frame , 1705 r and omly selected individuals were invited to diabetes screening 10 years later ( unscreened population ) . Patients without known diabetes from both population s were invited for a health assessment . Results Of 3390 eligible individuals without diabetes , 1442 ( 43 % ) attended for health assessment , with no significant difference in attendance between groups . Thirteen years after the commencement of screening , self-rated functional health status and health utility were identical between the screened and unscreened population s. Clinical measures , self-reported medication and cardiovascular morbidity were similar between the two groups . Conclusions Screening for diabetes is not associated with long-term harms at the population level . However , screening has limited long-term impact on those testing negative ; benefits may largely be restricted to those whose diabetes is detected early through screening Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease ( CHD ) risk could lower patients ' predicted Framingham CHD risk vs. usual care . Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospect i ve , controlled , cluster-r and omised trial in nine European countries , among patients at moderate cardiovascular risk . Following baseline assessment s , physicians in the intervention group calculated patients ' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme . Usual care physicians did not calculate patients ' risk and provided usual care only . The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care . Results Of 1103 patients across 100 sites , 524 patients receiving intervention , and 461 receiving usual care , were analysed for efficacy . After 6 months , mean predicted risks were 12.5 % with intervention , and 13.7 % with usual care [ odds ratio = 0.896 ; p = 0.001 , adjusted for risk at baseline ( 17.2 % intervention ; 16.9 % usual care ) and other covariates ] . The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention ( 25.4 % ) than usual care ( 14.1 % ; p < 0.001 ) , and 29.3 % of smokers in the intervention group quit smoking vs. 21.4 % of those receiving usual care ( p = 0.04 ) . Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients ' modifiable risk factor profile , and lowered predicted CHD risk compared with usual care . By combining this strategy with more intensive treatment to reduce residual modifiable risk , we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice Objective To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care . Design Pragmatic multicentre r and omised controlled trial . Setting General practice s throughout Australia , except Northern Territory , 2009 - 11 . Participants Of 2185 patients from 119 general practice s who were eligible for drug treatment for hypertension according to national guidelines 416 ( 19.0 % ) achieved their individual blood pressure target during a 28 day run-in period of monotherapy . After exclusions , 1562 participants not at target blood pressure ( systolic 150 ( SD 17 ) mm Hg , diastolic 88 ( SD 11 ) mm Hg ) were r and omised ( 1:2 ratio ) to usual care ( n=524 ) or the intervention ( n=1038 ) . Intervention Computer assisted clinical profiling and risk target setting ( all participants ) with intensified follow-up and stepwise drug titration ( initial angiotensin receptor blocker monotherapy or two forms of combination therapy using angiotensin receptor blockers ) for those r and omised to the intervention . The control group received usual care . Main outcome measures The primary outcome was individual blood pressure target achieved at 26 weeks . Secondary outcomes were change in mean sitting systolic and diastolic blood pressure , absolute risk for cardiovascular disease within five years based on the Framingham risk score , and proportion and rate of adverse events . Results On an intention to treat basis , there was an 8.8 % absolute difference in individual blood pressure target achieved at 26 weeks in favour of the intervention group compared with usual care group ( 358/988 ( 36.2 % ) v 138/504 ( 27.4 % ) ) : adjusted relative risk 1.28 ( 95 % confidence interval 1.10 to 1.49 , P=0.0013 ) . There was also a 9.5 % absolute difference in favour of the intervention group for achieving the classic blood pressure target of ≤140/90 mm Hg ( 627/988 ( 63.5 % ) v 272/504 ( 54.0 % ) ) : adjusted relative risk 1.18 ( 1.07 to 1.29 , P<0.001 ) . The intervention group achieved a mean adjusted reduction in systolic blood pressure of 13.2 mm Hg ( 95 % confidence interval −12.3 to −14.2 mm Hg ) and diastolic blood pressure of 7.7 mm Hg ( −7.1 to −8.3 mm Hg ) v 10.1 mm Hg ( −8.8 to 11.3 mm Hg ) and 5.5 mm Hg ( −4.7 to −6.2 mm Hg ) in the usual care group ( P<0.001 ) . Among 1141 participants in whom five year absolute cardiovascular risk scores  were calculated from baseline to the 26 week follow-up , the reduction in risk scores was greater in the intervention group than usual care group ( 14.7 % ( SD 9.3 % ) to 10.9 % ( SD 8.0 % ) ; difference −3.7 % ( SD 4.5 % ) and 15.0 % ( SD 10.1 % ) to 12.4 % ( SD 9.4 % ) ; −2.6 % ( SD 4.5 % ) : adjusted mean difference −1.13 % ( 95 % confidence interval −0.69 % to −1.63 % ; P<0.001 ) . Owing to adverse events 82 ( 7.9 % ) participants in the intervention group and 10 ( 1.9 % ) in the usual care group had their drug treatment modified . Conclusions In a primary care setting intensive structured care result ed in higher levels of blood pressure control , with clinical ly lower blood pressure and absolute risk of future cardiovascular events overall and with more people achieving their target blood pressure . An important gap in treatment remains though and applying intensive management and achieving currently advocated risk based blood pressure targets is challenging OBJECTIVE The aim of this study was to explore beliefs and attitudes about refusing health screening in general practice . METHODS In 1991 , in Ebeltoft , Denmark people aged between 30 and 50 years were invited to participate in a 5-year r and omized , controlled , population -based project testing the value of health screenings and health discussion s in general practice . In 1994 , non- participants who declined the offered  health screening but expressed willingness to be contacted in the future were asked to participate in a qualitative interview . They were drawn by stratified purpose ful sampling which reflected variation in perceived health , body mass index , age and sex . The sample comprised six men and 12 women RESULTS Some had not participated because they were busy , felt healthy or had recently been examined . The non- participants emphasized the limitations of health screening and did not want possible risk factors to be revealed , or their feeling of good health to be disturbed . They stressed the individual 's own responsibility for maintaining good health and believed that a positive attitude promoted health . They would contact their GP if they had symptoms . CONCLUSION Non- participants have rational views on risk factor testing and on their own responsibility for maintaining health . Non-attendance was due to a conscious choice which included consulting their own GP Aims /hypothesisThe aim of this study was to assess the impact of invitation to screening for type 2 diabetes and related cardiovascular risk factors on population mortality .  Methods This was a parallel-group population -based cohort study including all men and women aged 40–65 years , free of known diabetes , registered with a single practice in Ely , UK ( n = 4,936 ) . In 1990–1992 , approximately one-third ( n = 1,705 ) were r and omly selected to receive an invitation to screening for diabetes ( with an OGTT ) and related cardiovascular risk factors . In the remaining two-thirds of the population , 1,705 individuals were r and omly selected for invitation to screening in 2000–2003 and 1,526 were not invited at any point during the follow-up period . All individuals were flagged for mortality until January 2008 . Results There were 345 deaths between 1990 and 1999 ( median 10 years follow-up ) . Compared with those not invited , individuals who were invited to the 1990–1992 screening round had a non-significant 21 % lower all-cause mortality ( HR 0.79 [ 95 % CI 0.63–1.00 ] , p = 0.05 ) after adjustment for age , sex and deprivation . There were 291 deaths between 2000 and 2008 ( median 8 years follow-up ) , with no significant difference in mortality between invited and non-invited participants in 2000–2003 . Compared with the non-invited group , participants who attended for screening at any time point had a significantly lower mortality and those who did not attend had a significantly higher mortality . Conclusions /interpretationInvitation to screening was associated with a non-significant reduction in mortality in the Ely cohort between 1990 and 1999 , but this was not replicated in the period 2000–2008 . This study contributes to the evidence concerning the potential benefits of population screening for diabetes and related cardiovascular risk factors South-East London Screening Study Group ( Department of Community Medicine , St Thomas 's Hospital and Medical School , London SE1 1EH , Engl and ) . A controlled trial of  multiphasic screening in middle-age : results of the South-East London Screening Study . International Journal of Epidemiology 1977;6:357 - 63 . The results of a controlled trial of multiphasic screening in general practice are presented . In 1967 , 7229 individuals aged between 40 and 64 years were r and omly allocated into either a  Screening or Control group .  The Screening group were invited to attend two screening sessions held about two years apart , while the Control group continued to receive conventional medical care . Both groups were then invited to undergo a health survey in 1972 - 73 which revealed no significant differences in morbidity between the two groups . Careful follow-up permitted detailed Screening-Control comparisons of various outcome measures -consultation and hospital admission rates , certified sickness absence from work , and mortality . Nine years after the initial screening , no significant differences were found between the two groups in any of the outcome measures . It is estimated that a similar screening programme for the entire middle-aged UK population would cost 142 million pounds at 1976 prices BACKGROUND The aim of this study was to investigate the long-term effects of one general health screening on mortality . METHOD After stratification and r and omization of a population of 450,000 inhabitants , two groups were formed , an  intervention group of 3064 people and a control group of 29,122 people .  From the National Cause of Death Register , data were collected as regards death and causes of deaths for 1970 - 1990 . RESULTS Multivariate analysis was used to correct for known confounders . We then found no differences between the groups regarding deaths from all causes , cardiovascular diseases , cancer or accidents and poisoning . CONCLUSIONS One general health screening seems to have little , if any value in preventing fatal diseases Background R and omised , controlled trials focusing on long-term psychological reactions to information about increased risk of coronary heart disease are scarce . Design A population -based r and omised , controlled , 5-year follow-up trial was conducted in general practice . Methods In 1991 , invitations were sent to 2,000 middle-aged people registered in the general practice s in the district of Ebeltoft , Denmark . A total of 1,507 ( 75.4 % ) agreed to participate and were r and omised into a control group and two intervention groups : one included health screening , a written feedback and an optional follow-up visit with the general practitioner ; the other included health screening , written feedback and a planned 45-min follow-up visit with the general practitioner . The participants were informed at screening about their risk of developing coronary heart disease . Psychological distress was measured by the GHQ-12 before screening and at the 1 and the 5-year follow-up . Results Before the screening ( 0 year ) , 1 and 5 years after there were no significant differences in the GHQ-12 score between the control group and the two intervention groups . Nor were there any differences related to information about increased risk of coronary heart disease between scores obtained at the 1 and the 5-year follow-up . Conclusion Middle-aged persons had no long-term psychological reaction after information about increased risk of developing coronary heart disease following a health screening in general practice evaluated by the GHQ-12,1 year and 5 years after the examinations In the Study of Men Born in 1913 it was possible to investigate the influence of repeated health examinations on mortality in a prospect i ve cohort study . On January 1 , 1963 , 1010 men in the experimental grop and 1956 in the control group were alive . The experimental group took part in repeated examinations in 1963 , 1967 , 1973 and 1980 . Overt diseases were treated accordingly . Newly detected hypertension was also treated . By the end of a 15-year-long observation period , the cumulative mortality in the experimental group ( 14.5 % ) was not significantly lower than that in the control group ( 15.7 % ) . In the experimental group , 855 took part . The mortality was significantly higher in the non-participating group . The autopsy frequency decreased for in-hospital deaths but increased for deaths outside hospital during the study period BACKGROUND Our aim was to investigate whether a nurse-coordinated multidisciplinary , family-based preventive cardiology programme could improve st and ards of preventive care in routine clinical practice . METHODS In a matched , cluster-r and omised , controlled trial in eight European countries , six pairs of hospitals and six pairs of general practice s were assigned to an intervention programme ( INT ) or usual care ( UC ) for patients with coronary heart disease or those at high risk of developing cardiovascular disease . The primary endpoints-measured at 1 year-were family-based lifestyle change ; management of blood pressure , lipids , and blood glucose to target concentrations ; and prescription of cardioprotective drugs . Analysis was by intention to treat . The trial is registered as IS RCT N 71715857 . FINDINGS 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC , respectively . In patients with coronary heart disease who smoked in the month before the event , 136 ( 58 % ) in the INT and 154 ( 47 % ) in the UC groups did not smoke 1 year afterwards ( difference in change 10.4 % , 95 % CI -0.3 to 21.2 , p=0.06 ) . Reduced consumption of saturated fat ( 196 [ 55 % ] vs 168 [ 40 % ] ; 17.3 % , 6.4 to 28.2 , p=0.009 ) , and increased consumption of fruit and vegetables  ( 680 [ 72 % ] vs 349 [ 35 % ] ; 37.3 % , 18.1 to 56.5 , p=0.004 ) , and  oily fish  ( 156 [ 17 % ] vs 81 [ 8 % ] ; 8.9 % , 0.3 to 17.5 , p=0.04 ) at 1 year were greatest in the INT group . High-risk individuals and partners showed changes only for fruit and vegetables ( p=0.005 ) . Blood-pressure target of less than 140/90 mm Hg was attained by both coronary ( 615 [ 65 % ] vs 547 [ 55 % ] ; 10.4 % , 0.6 to 20.2 , p=0.04 ) and high-risk ( 586 [ 58 % ] vs 407 [ 41 % ] ; 16.9 % , 2.0 to 31.8 , p=0.03 ) patients in the INT groups . Achievement of total cholesterol of less than 5 mmol/L did not differ between groups , but in high-risk patients the difference in change from baseline to 1 year was 12.7 % ( 2.4 to 23.0 , p=0.02 ) in favour of INT . In the hospital group , prescriptions for statins  were higher in the INT group ( 810 [ 86 % ] vs 794 [ 80 % ] ; 6.0 % , -0.5 to 11.5 , p=0.04 ) . In general practice s in the intervention groups ,  angiotensin-converting enzyme inhibitors  ( 297 [ 29 % ] INT vs 196 [ 20 % ] UC ; 8.5 % , 1.8 to 15.2 , p=0.02 ) and  statins  ( 381 [ 37 % ] INT vs 232 [ 22 % ] UC ; 14.6 % , 2.5 to 26.7 , p=0.03 ) were more frequently prescribed . INTERPRETATION To achieve the potential for cardiovascular prevention , we need local preventive cardiology programmes adapted to individual countries , which are accessible by all hospitals and general practice s caring for coronary and high-risk patients Within a community-wide heart disease prevention effort , it was hypothesized that personalized risk factor screening and education would result in modified health behaviors and reduced risk factor levels for coronary heart disease . Adults from a population sample were r and omized to a community-wide screening and education program or were excluded from that program for 1 year . At the end of that year , both groups were measured for risk factor levels and related health behaviors . Those who received the screening and education program had significantly lower risk factor levels and other evidence of health behavior change , including lower blood cholesterol ( 206.9 vs 211.5 mg/dl ) , lower diastolic blood pressure ( 68.7 vs 70.0 mm Hg ) , lower resting heart rate ( 71.4 vs 72.7 bpm ) , and increased selection of low-fat and low-sodium meals in local restaurants . These data suggest that systematic risk factor screening and education may result in lower population risk for coronary heart disease
target: General practice -based health checks are associated with statistically significant , albeit clinical ly small , improvements in surrogate outcome control , especially among high-risk patients .
background: BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults .
  AIM This review focuses on general practice -based health checks and their effects on both surrogate and final outcomes .