Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
PLoS Med. 2019 Jul 30;16(7):e1002863. doi: 10.1371/journal.pmed.1002863. eCollection 2019 Jul.
The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research aimed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years' follow-up.
A controlled interrupted time series study was conducted. Participants were registered with general practices in the Clinical Practice Research Datalink (CPRD) in England and received health checks between 1 April 2010 and 31 December 2013. Control participants, who did not receive a health check, were matched for age, sex, and general practice. Outcomes were blood pressure, body mass index (BMI), smoking, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDL). Analyses estimated the net effect of health check by year, allowing for the underlying trend in risk factor values and baseline differences between cases and controls, adjusting for age, sex, deprivation, and clustering by general practice. There were 127,891 health check participants and 322,910 matched controls. Compared with controls, health check participants had lower BMI (cases mean 27.0, SD 4.8; controls 27.3, SD 5.6, Kg/m2), systolic blood pressure (SBP) (cases 129.0, SD 14.3; controls 129.3, SD 15.0, mm Hg), and smoking (21% in health check participants versus 27% in controls), but total and HDL cholesterol were similar. Health check participants were more likely to receive weight management advice (adjusted hazard ratio [HR] 5.03, 4.98 to 5.08, P < 0.001), smoking cessation interventions (HR 3.20, 3.13 to 3.27, P < 0.001), or statins (HR 1.24, 1.21 to 1.27, P < 0.001). There were net reductions in risk factor values up to six years after the check for BMI (-0.30, -0.39 to -0.20 Kg/m2, P < 0.001), SBP (-1.43, -1.70 to -1.16 mm Hg, P < 0.001), and smoking (17% in health check participants versus 25% in controls; odds ratio 0.90, 0.87 to 0.94, P < 0.001). The main study limitation was that residual confounding may be present because randomisation was not employed; health check-associated measurement introduced differential recording that might cause bias.
Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions. Risk factor values show net reductions up to six years following a health check in BMI, blood pressure, and smoking, which may be of public health importance.
英国国民保健制度（NHS）于 2009 年推出了一项面向全人群的心血管疾病（CVD）预防计划，称为 NHS 健康检查。本研究旨在测量健康检查计划在六年随访期间的心血管风险管理和心血管风险因素结果。
进行了一项对照中断时间序列研究。参与者在英格兰的临床实践研究数据链接（CPRD）的常规实践中注册，并在 2010 年 4 月 1 日至 2013 年 12 月 31 日之间接受健康检查。未接受健康检查的对照组参与者与年龄、性别和常规实践相匹配。结果是血压、体重指数（BMI）、吸烟和总胆固醇（TC）和高密度脂蛋白胆固醇（HDL）。分析估计了健康检查的净效应，考虑了风险因素值的潜在趋势和病例与对照组之间的基线差异，并根据年龄、性别、贫困和常规实践进行了调整。共有 127891 名健康检查参与者和 322910 名匹配对照。与对照组相比，健康检查参与者的 BMI（病例平均 27.0，SD 4.8；对照组 27.3，SD 5.6，kg/m2）、收缩压（SBP）（病例 129.0，SD 14.3；对照组 129.3，SD 15.0，mmHg）和吸烟（健康检查参与者中 21%，对照组中 27%）较低，但总胆固醇和 HDL 胆固醇相似。健康检查参与者更有可能接受体重管理建议（调整后的危险比[HR]5.03，4.98 至 5.08，P<0.001）、戒烟干预（HR 3.20，3.13 至 3.27，P<0.001）或他汀类药物（HR 1.24，1.21 至 1.27，P<0.001）。在检查后长达六年的时间内，风险因素值出现净下降，BMI 下降 0.30（-0.39 至-0.20 kg/m2，P<0.001），SBP 下降 1.43（-1.70 至-1.16 mmHg，P<0.001），吸烟率下降 17%（健康检查参与者中为 17%，对照组中为 25%；比值比 0.90，0.87 至 0.94，P<0.001）。本研究的主要局限性是由于未进行随机化，可能存在残余混杂；健康检查相关的测量引入了可能导致偏差的差异记录。
我们的研究结果表明，接受健康检查的人通常比对照组的风险因素值低，并且更有可能接受风险因素干预。在 BMI、血压和吸烟方面，健康检查后六年内风险因素值呈净下降趋势，这可能具有公共卫生意义。
