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Which Recommendations Should Clinicians Follow for a Cardiovascular Health Check?

Bart S. Ferket, MD; Ersen B. Colkesen, MD; Jacob J. Visser, MD, PhD; Sandra Spronk, PhD; Roderik A. Kraaijenhagen, MD, PhD; Ewout W. Steyerberg, PhD; M. G. Myriam Hunink, MD, PhD

Arch Intern Med. 2010;170(1):27-40.

Objective  To appraise guidelines on cardiovascular risk assessment to guide selection of screening interventions for a health check.

Data Sources  Guidelines in the English language published between January 1, 2003, and May 2, 2009, were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National Guideline Clearinghouse, National Library for Health, Canadian Medical Association Infobase, and G-I-N International Guideline Library.

Study Selection  We included guidelines developed on behalf of professional organizations from Western countries, containing recommendations on cardiovascular risk assessment for the apparently healthy population. Titles and abstracts were assessed by 2 independent reviewers. Of 1984 titles identified, 27 guidelines met our criteria.

Data Extraction  Rigor of guideline development was assessed by 2 independent reviewers. One reviewer extracted information on conflicts of interest and recommendations.

Results  Sixteen of 27 guidelines reported conflicts of interest and 17 showed considerable rigor. These included recommendations on assessment of total cardiovascular risk (7 guidelines), dyslipidemia (2), hypertension (2), and dysglycemia (7). Recommendations on total cardiovascular risk and dyslipidemia included prediction models integrating multiple risk factors, whereas remaining recommendations were focused on single risk factors. No consensus was found on recommended target populations, treatment thresholds, and screening tests.

Conclusions  Differences among the guidelines imply important variation in allocation of preventive interventions. To make informed decisions, physicians should use only the recommendations from rigorously developed guidelines.

Author Affiliations: Departments of Epidemiology (Drs Ferket, Spronk, and Hunink), Radiology (Drs Ferket, Visser, Spronk, and Hunink), and Public Health (Dr Steyerberg), Erasmus MC, Rotterdam, the Netherlands; NDDO Institute for Prevention and Early Diagnostics (Drs Ferket, Colkesen, and Kraaijenhagen) and Department of Cardiology, Academic Medical Center (Dr Colkesen), Amsterdam, the Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (Dr Hunink).

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