title: Screening for increased cardiometabolic risk in primary care: a systematic review.
abstract: BACKGROUND
  Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear.
  
  
  OBJECTIVE
  To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy.
  
  
  METHODS
  Systematic review of studies performed in primary care in Western countries.
  
  
  METHODS
  MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities.
  
  
  RESULTS
  The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995-2012) were conducted in apparently healthy populations: three used a stepwise method. Response rates varied from 24% to 79%. Twenty-one studies (1967-2012) were performed in mixed populations; one used a stepwise method. Response rates varied from 50% to 75%. Prevalence rates could not be compared because of heterogeneity of used thresholds and eligible populations. Observed time trends were a shift from mixed to apparently healthy populations, increasing use of risk scores, and increasing use of stepwise screening methods.
  
  
  CONCLUSIONS
  The optimal screening strategy in primary care is likely stepwise, in apparently healthy people, with the use of risk scores. Increasing public awareness and actively involving GPs might facilitate screening efficiency and uptake.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors.forename: Corine den
authors.initials: Cd
authors.lastname: Engelsen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors.forename: Paula S
authors.initials: PS
authors.lastname: Koekkoek
authors.affiliation: CAPHRI-School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Merijn B
authors.initials: MB
authors.lastname: Godefrooij
authors.affiliation: CAPHRI-School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Spigt
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D006293:Health Promotion; D006801:Humans; D007333:Insulin Resistance; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D010353:Patient Education as Topic; D010358:Patient Participation; D011320:Primary Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
keywords: cardiometabolic risk factors; primary health care; screening