Effect of the NHS Health Check programme on cardiovascular disease risk factors during 6 years' follow-up: matched cohort study

Abstract

BackgroundThe National Health Service (NHS) Health Check (NHSHC) is a primary prevention programme aimed at reducing the risk of cardiovascular diseases. We evaluated the effect of this programme up to 6 years after its implementation on risk factors and provision of risk management interventions. MethodsWe conducted a population-based matched cohort study using primary care electronic health records from the Clinical Practice Research Datalink. Case participants had received the NHSHC in England between April 1, 2010, and Dec 31, 2013. A control cohort matched for age, sex, and general practice did not receive a health check. All participants with matched controls were included in the analysis. An interrupted time-series analysis was conducted to evaluate changes in body-mass index, blood pressure, total cholesterol, and smoking. The association between the NHSHC and risk management interventions was evaluated using time-to-event analysis. All models were adjusted for age, sex, and fifth of deprivation. FindingsThere were 127 891 NHSHC participants and 322 910 matched controls. After 6 years' follow-up, men and women who had received a health check had lower body-mass index (by 0·30 kg/m2 [95% CI 0·16–0·44] and 0·30 [0·14–0·46], respectively) and lower systolic blood pressure (by 1.20 mm Hg [95% CI 0·81–1·59] and 1·58 [1·21–1·95], respectively) than controls. The NHSHC was not associated with observable effects on total cholesterol. Although smoking was initially less frequent among NHSHC participants, men and women in the health check group were more likely to be non-smokers than controls at the end of follow-up (men, odds ratio 0·89 [95% CI 0·84–0·94]; women, 0·91 [0·86–0·97]). The NHSHC was associated with an increase in the prescribing of statins (hazard ratio 1·24, 95% CI 1·21–1·27) and provision of smoking cessation interventions (3·20, 3·13–3·27). InterpretationThe largest benefit of the NHSHC programme was observed in relation to reductions in smoking prevalence up to 6 years after implementation of the NHSHC. There were minor reductions in other risk factors that might not have public health relevance. FundingThis work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. SA was supported by the Government of Saudi Arabia.