On receiving a link in my local authority’s e-newsletter, I entered my details in Public Health England’s ‘One You’ online heart age checker.1,2 I am a 34 year-old, male, non-smoker, (BMI) 21.5, normal systolic blood pressure (113 mmHg), cholesterol unknown, with no family history or other risk factors for heart disease. I was told my heart age is 34 and given lifestyle advice.
However, I was then told my cholesterol ‘Is not known — GET TESTED’ in large red letters, and that, although I wouldn’t be automatically invited by my GP to have my cholesterol checked, I should get into the habit of ‘knowing my numbers’.
Using the information I provided (without cholesterol), my QRisk2 score could easily be calculated at 0.6%.3 Even if my cholesterol was raised, statin medication would not be indicated according to current guidelines, but rather lifestyle advice,4 which was recommended anyway.
Despite large meta-analyses, there is no evidence that cardiovascular screening of asymptomatic subjects reduces mortality or morbidity, with little attention paid to the harms of screening in studies to date.5 There remain significant concerns about the clinical and cost-effectiveness of the politically driven NHS Health Check Programme for 40–74-year-olds.6 The likelihood of benefit of cholesterol screening in younger groups under 40 years seems even more unlikely.
All this when the NHS and primary care are under huge strain trying to provide evidence-based care that is actually needed. Why is this irresponsible advice being given and when will it be changed?
- © British Journal of General Practice 2018