Individualizing the Screening Interval for High-risk CVD Patients

Screening for high cardiovascular disease (CVD) risk should done based on the individual rather than by time intervals, according to a new study published in The Lancet Public Health.

Currently, the American Heart Association, European Society of Cardiology, and UK National Health Service guidelines recommend a five-year health check interval for screening of individuals at high risk for CVD. This health check comprises measuring various risk factors associated with CVD including systolic blood pressure, cholesterol profile, blood glucose, and smoking status. If lifestyle interventions are inadequate to decrease the risk, the guidelines recommend primary preventive medication such as statins. However, the five-year screenings are not based on primary research evidence.

In this study, the researchers evaluated 7,000 English men and women from the Whitehall II study to estimate the optimal screening interval. They measured their CVD risk factors according to the current five-year interval guidelines over a 22-year follow-up while gathering data on CVDs using national electronic health and death records.

The study indicated that the current screening intervals were unnecessarily frequent for low-risk patients and insufficiently frequent for intermediate-risk patients. It showed that patients at low risk for CVD spent an average of nine years in that risk category before progressing to intermediate low-risk, a risk category where participants spent an average of seven years before moving to intermediate-high risk. However, the duration spent in the intermediate-high risk category was only four years, and subsequently, over 70% of participants progressed to the high-risk classification that leads to the administration of preventive medication if lifestyle intervention do not mitigate risk.

A Need for Optimized Intervals

“Our study shows that by optimizing the screening intervals, 8% of myocardial infarcts and strokes could be prevented without increase in health care costs,” said Joni Lindbohm, MD, PhD, from the University of Helsinki, and lead author of this study, in a press release. “This means that during the next 20 years, in the English population aged now 40 to 64, the number of new myocardial infarcts or strokes prevented annually could reach 5000.”

The researchers noted that an individualized screening interval would allow for more effective CVD prevention by way of lifestyle intervention of preventive medication. “The results are promising, but national guidelines are rarely changed based on one study,” said professor Mika Kivimäki, director of the Whitehall II study at University College London, and one of the study’s authors.

“The benefits of individualized screening intervals should be further studied in a randomized control trial before changing the guidelines.”