The concept of general health checkups to identify disease at a stage at which early intervention could be effective has been promoted for nearly 100 years.1 Both patients and primary care physicians are interested in such examinations, which can include detailed history taking, physical examination, extensive laboratory testing, and imaging.2,3 However, there has been little evidence to support the benefits of such checkups, and the US Preventive Services Task Force recommends a limited range of age-, sex-, and risk-specific examinations and tests.4 The goal of this review was to estimate the effect of health checkups on morbidity and mortality based on primary care–or community-based randomized controlled trials (RCTs) with long-term follow-up in adults.
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As the authors of commentaries on the same Cochrane review on which Prochazka and Caverly have commented, we were surprised that they failed to discuss the Million Hearts Initiative and the new annual wellness visit for Medicare beneficiaries. Although the available Million Hearts Initiative policies are vague on the frequency of checks for the presence of cardiovascular disease (CVD) risk factors, this is not the case with the Medicare policy. Are these not general health checks? Prochazka and Caverly acknowledge the advent of new, cheap and individually effective interventions to reduce risk factors (such as generic statins), and the lack of recent research available to the review, and yet state that the "belief in the value of general health checks persists despite the accumulating evidence". What accumulating evidence? The advent of new interventions and the concept of reducing global CVD risk should have led to more recent trials of CVD risk factor screening programmes by government agencies, but unfortunately it did not, and that window of opportunity is now closing. Despite the lack of modern clinical trial evidence, the English Government has embarked on a programme, NHS Health Checks, to screen all 40-74 year olds for CVD risk factors, based on expert advice, local experiments, cost-effectiveness modelling, and strong and universal primary health care services. While we can deplore the historic hiatus in clinical trials, we suggest that the time to call for more of them has passed. Could patients with high CVD risk be denied statin treatment in a trial? We need to evaluate the impact of what is happening before our eyes, whether policy-driven or not.
1. Frieden TR, Berwick DM. The “Million Hearts” Initiative — Preventing Heart Attacks and Strokes. New England Journal of Medicine 2011;365(13):e27.
2. Cholesterol Treatment Trialists C. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. The Lancet 2012;380(9841):581-90.
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