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NHS Health Checks
The NHS Health Check is available for adults in England aged 40-74 years. It is NOT a 'full-body MOT' (see below for more about 'screening') but is targeted to specifically assess the risk of developing stroke, heart disease, diabetes and kidney disease.
To do this the health check assesses your 'risk' of developing these problems. This is done using a tool that looks at your age, sex, body mass index (how fat or thin you are) blood pressure, cholesterol (good and bad) and blood sugar level. The tool can then (pretty accurately) calculate your risk of developing circulatory disease in the next 10 years. Of course it's worth noting that while the risk calculation is very accurate, that doesn't tell you what WILL or WON'T happen. How helpful is it to know that you have a 50:50 chance? Or a 20:80 chance?
We follow national guidelines and divide the risk into three groups. A ten-year risk below 10% is regarded as LOW risk, between 10-20% is MEDIUM risk and higher than 20% is HIGH risk.
The advice given to these three groups is shown below:
ADVICE FOR ALL |
You can’t change your genes but we can ALL improve our risk by modifying lifestyle factors (smoking, alcohol, diet, exercise etc) and the nurse / HCA will have spoken to you about this and given you a summary advice sheet. (AVAILABLE TO DOWNLOAD HERE)
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LOW RISK
(<10%) |
You are unlikely to benefit much from taking regular drugs to lower your risk further (aspirin or cholesterol lowering drugs). We recommend that there is no need for you to take these forms of medication in addition to the lifestyle changes we have outlined.
We do recommend rechecking your risk in 5 years time with another health check (up to the age of 75) |
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The lifestyle advice outlined for you is important and might bring you down to ‘low-risk’. However in addition to this drug therapy could be considered. The main drugs for reducing risk are drugs to lower blood pressure and drugs to lower cholesterol (statins). These drugs only reduce the risk while they are taken so you would need to take them for life to benefit. Of course taking drugs themselves is not without risk of side effects and therefore this is not always a straightforward decision. If you would like to consider drug treatment or to discuss the risks and benefits in more detail, please book a routine appointment with one of the doctors.
We do recommend rechecking your risk in 5 years time with another health check (up to the age of 75) |
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The lifestyle measures discussed are very important in lowering your risk but are unlikely to be enough to bring you into a ‘low-risk’ group. In addition to this we should consider drug treatment. The main drugs for reducing risk are drugs to lower blood pressure and drugs to lower cholesterol (statins). Risk rises with age so normally you would need to take these drugs for the rest of your life to maintain the benefit. Of course taking drugs is not without risk of side effects but for high-risk individuals like yourself there is clear evidence that overall the benefits outweigh the risks.
Please book a routine appointment with one of the doctors to talk this through in more detail and for appropriate treatment to be started. |
More about Medicines
Should I take low dose aspirin?
This question has been around for many years now, the latest look at ALL the available evidence concluded that Aspirin DOES reduce the risk of heart disease and stroke but at the expense of a significantly increased risk of bleeding - the conclusion is that for most people the benefit does NOT outweigh the risks. This is for patients WITHOUT a past history of stroke or heart disease (so-called 'Primary Prevention - i.e. we are aiming to prevent the FIRST episode of disease). Patients who have ALREADY had a heart or brain event (secondary prevention) are at much higher risk and for them the benefit outweighs the risk. More here:
http://www.mrc.ac.uk/Newspublications/News/MRC006084
How good are cholesterol-lowering drugs (statins)?
Drugs are not an off-switch. They reduce the risk of events, they do not prevent all events. So exactly how good are they? There are a numer of ways of describing these statistics as follows:
Relative Risk Reduction - this is the drug companies favourite statistic, it sounds impressive to say that statins reduce risk by 25%. This figure will vary depending on dose but roughly speaking it's about right. However it doesn't tell you what that means for an individual because we need to know your baseline risk (which is what the nurse calculated for you).
Absolute Risk Reduction - if my baseline risk is low (10% risk say) then a 25% reduction is less significant. I was unlikely to have an event, and now I'm taking drugs this small risk is reduced to 7% (say) - not a big difference. If my baseline risk is very high (say 40%) then this reduction is more significant (now down to 30%). An easy way to visualise this is to turn these percentages into real people - if we treat 100 people with a risk of 40% then 10 of them will avoid an event that they would otherwise have had (but for the remaining 90 patients the drug made no difference, 30 of whom will still have a bad event anyway). These are real world numbers not just risks and percentages, Ben Goldacre champions using 'Natural Numbers' like this whenever medical statistics of a new 'breakthrough' are presented - sadly it does not seem to be catching on as it sounds less impressive to say
'Treatment with statins to reduce the risk of heart attacks and strokes over ten years in 100 patients with a 20% risk of Cardiovascular disease reduces the number of heart attacks, strokes and bypass surgery from 20 to 15'
...than to say
'Statins reduce risk of cardiovascular disease by 25%'
Number needed to treat (NNT)- this follows directly fromt the last calculation, we can say that in this instance (baseline risk of 20%) we only need to treat 20 people for 1 to benefit (clarifying that 'treat' means take statin for 10 years and 'benefit' means avoid heart attack, stroke or bypass surgery').
You can play with YOUR risk figures at the NNT calculator on Chris Cates excellent website here...
http://www.nntonline.net/visualrx/examples/statins/?INPUT_BLR=20
How likely is it to benefit ME?
We're moving back to risks and percentages but it follows that if your Number needed to treat is 20, then there is a 95% chance that the drugs will do you no good, and only a 1 in 20 chance that you will actually benefit from taking them. Suddenly it doesn't sound nearly so impressive, but if we remember that around 200,000 people die from cardiovascular disease every year then if we can reduce this by 25% we have prevented 50,000 deaths. We just need to understand that we may need to treat 10 million people to achieve this. Perhaps you are one of these 10 million in order to save 50,000?
More about Screening
'Screening' means looking for disease (or factors that could lead to disease) before it becomes apparant through symptoms on the understanding that 'prevention is better than cure'.
As Ben Goldacre (author of the excellent book 'Bad Science') would say - it's more complicated than that. For example, is the screening test acceptable, affordable, sensitive, specific and reliable, and is early treatment more effective than later treatment (at the symptomatic stage) and is the treatment also affordable, effective and acceptable? These requirements are known as The Wilson-Jungner Criteria for screening.
Private companies can make money from offering screening programmes to their customers. Not all of these programmes fulfill these criteria, a full body MRI scan for instance may find lots of innocent abnormalities that might not ever cause disease, but once found they will certainly cause concern and might trigger a sequence of further investigation and treatment from which the patient will not necessarily benefit.
It is against this background that the idea of 'Health Checks' must be assessed. It is not simply a matter of stating that 'prevention is better than cure' - we have to PROVE that this is the case. Over the years many 'screening programmes' have been proposed but some of these have not been proven to be sufficiently beneficial or accurate to justify rolling the programme out to the entire population. PSA screening for prostate cancer is an example where the benefits and risks of screening are finely balanced, we stick to current NHS advice only to offer PSA testing to men aged over 50 who have been fully informed of the pros and cons of screening. Find out more about NHS Screening Programmes HERE.
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