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Is cardiovascular screening effective?

Vascular screening and management of high-risk patients aged 40-74 may prevent 2,000 deaths a year, according to the Department of Health (DH). A further 9,500 heart attacks and strokes could also be prevented by the screening programme, which will be rolled out across England in 2009-10.

In a recent online debate hosted by the British Medical Journal (BMJ), Professor Rod Jackson from the University of Auckland, New Zealand suggests that if appropriately targeted, the greatest benefits will come from treating high-risk patients who have had a cardiovascular event.

Professor Simon Capewell from the University of Liverpool argues that screening programmes favour affluent and educated individuals, thereby increasing inequalities.

He goes on to suggest drug treatment does not treat the underlying disease, and that public health-based interventions that target the whole population are cheaper and more effective than tablets.

The World Health Organization (WHO) argue that in the short-term treating patients with a triple therapy of aspirin, off-patent statins and hypertensives would not only be more cost-effective, but would prevent more cardiovascular events than public health based interventions to reduce salt intake, cholesterol levels and obesity.

WHO point out that if this triple therapy were offered to half of high-risk patients, there would be a 10% fall in the national coronary disease event rate in less than 10 years. At present most patients with existing cardiovascular disease are not receiving it.

The authors of a recent government consultation on this screening programme suggest that GPs should be encouraged and rewarded for managing patients with existing cardiovascular disease first.