Measurement and management of cardiovascular risk factors--is screening worthwhile?

[Ischemic heart disease risk in the west Valladolid health area]

INTRODUCTION AND OBJECTIVES

Cardiovascular diseases, especially ischemic heart disease present a high morbidity and mortality rate in our country. The aim of this study is to estimate the average coronary risk of people living in the west Valladolid Health District.

METHODS

Cross-sectional study in a random sample of 369 people between 35 and 64 years of age from the general population, of systolic blood pressure, total serum cholesterol and cigarette smoking. With these three factors, plus sex and age, individual coronary risk was calculated through the Dundee Coronary Risk-Disk method.

RESULTS

The coronary risk in the studied district, which is to say the individual probability of suffering a coronary event within five years of life, was estimated in 5.22 (95% CL: 4.75-5.69), higher among men, 5.66 (95% CL: 4.95-6.36), than among women, 4.63 (95% CL: 4.15-5.11). A descendent trend in coronary risk as age increases was found.

CONCLUSIONS

This method is relatively easy to obtain for community studies and simple to use for individual risk. The coronary risk of a person from the studied population has similar levels to figures found in other studies from our settings. The community levels of isolated coronary risk factors do not permit the establishment the best option in coronary risk control, and only a multicausal approach will allow us to evaluate the most efficient interventions for each age group and sex.

A mobile screening unit, practicalities and problems

The need for a mobile screening unit to travel throughout Scotland to measure and modify cardiovascular risk factors in the apparently healthy working population was fulfilled by the conversion of a double-decker bus. The aim of the project was to assess the incidence of risk factors in healthy individuals and to modify their risk factors by individual counselling. Many unforeseen practical problems were encountered and overcome during the planning stage and during the project. The team of specially trained staff spent three and a half years screening more than 20,000 people throughout Scotland. This project provides a model for other screening projects involving a multicentre/scattered cohort.

Screening for risk factors for cardiovascular disease: a psychological perspective

The success of cardiovascular disease (CVD) risk factor screening programmes depends heavily on good uptake rates and the extent of risk factors modification following screening. It is thus important to try to understand what affects people's decision to attend a screening appointment and their motivation to change their lifestyle, if necessary, following screening. This paper summarises three studies undertaken to describe uptake of screening and risk factor modification and to identify the psychological factors involved. The studies took place in two settings: a worksite mobile screening service and a city health centre screening programme. The results identified a number of sociodemographic, personal and organizational factors involved in screening behaviour which offer suggestions for effective planning of screening programmes.

Heart and arterial disease risk factor levels in the Scottish workforce: cross-sectional study of risk factor levels. The SHARP Committee. Scottish Heart and Arterial Disease Risk Prevention

Between 1991-93 a specially trained team of nurses screened 19,435 subjects from various workforces in different regions of Scotland to identify cardiovascular disease risk factor levels in the Scottish working population. The regions visited provided a wide geographical spread. Name, age, occupation, social class, personal and family history of cardiovascular disease were recorded along with consumption of tobacco, alcohol and salt. Height and weight were measured and Body Mass Index (BMI) calculated; systolic (SBP) and diastolic (DBP) blood pressure, blood glucose and blood cholesterol were also measured. The proportion of social class I-IV in men studied was 49, 22, 22, and 7% respectively and in women 28, 29, 39 and 5%. Fifty two per cent of men and 61% of women had never smoked and 24% of men and 17% of women had previously stopped smoking. Twenty one per cent of both sexes were still smoking. Eighteen per cent of men drank more than 21 units of alcohol per week and 3.4% of women drank more than 14 units per week. Mean values of SBP and DBP increased with age and the percentage with hypertension (> or = 148/90 mm Hg) in men and women was 5% and 24% respectively. Mean BMI was slightly higher in men than women (25.3 & 24.5 respectively) and there was a significant (p < 0.01) rise in BMI with age in both sexes. Forty six per cent of men and 32% of women were classified as overweight (BMI > 25) while 9% of men and 9% of women were classified as obese (BMI > 30).(ABSTRACT TRUNCATED AT 250 WORDS)