title: Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care.
abstract: In contrast to structured, integrated risk assessment in primary care, unstructured risk factor screening outside primary care and corresponding recommendations to consult a general practitioner (GP) are often based on one abnormal value of a single risk factor. This study investigates the advantages and disadvantages of unstructured screening of blood pressure and cholesterol outside primary care.
  
  
  
  After the baseline visit of the Netherlands Epidemiology of Obesity study (population-based prospective cohort study in persons aged 45-65 years, recruited 2008-2012) all participants received a letter with results of blood pressure and cholesterol, and a recommendation to consult a GP if results were abnormal. Four years after the start of the study, participants received a questionnaire about the follow-up of their results.
  
  
  
  The study population consisted of 6343 participants, 48% men, mean age 56 years, mean body mass index 30 kg/m(2). Of all participants 66% had an abnormal result and, of these, 49% had a treatment indication based on the risk estimation system SCORE-NL 2006. Of the 25% of the participants who did not consult a GP, 40% had a treatment indication. Of the participants with an abnormal result 19% were worried, of whom 60% had no treatment indication.
  
  
  
  In this population 51% of the participants with an abnormal result had unnecessarily received a recommendation to consult a GP, and 10% were unnecessarily worried. GPs should be informed about the complete risk assessment, and only participants at intermediate or high risk should receive a recommendation to consult a GP.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, The Netherlands Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands a.w.de_boer@lumc.nl.
authors.forename: Anna W
authors.initials: AW
authors.lastname: de Boer
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, The Netherlands.
authors.forename: Renée
authors.initials: R
authors.lastname: de Mutsert
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, The Netherlands Department of Internal Medicine, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: den Heijer
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, The Netherlands Department of Thrombosis and Haemostasis, Leiden University Medical Centre, The Netherlands.
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.affiliation: Department of Thrombosis and Haemostasis, Leiden University Medical Centre, The Netherlands Department of Cardiology, Leiden University Medical Centre, The Netherlands.
authors.forename: Johan W
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands.
authors.forename: Jeanet W
authors.initials: JW
authors.lastname: Blom
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands.
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000379:methods*; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends
keywords: Cardiovascular diseases; general practice; primary prevention