title: Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis.
abstract: BACKGROUND
  The National Health Service Health Check program in England is the largest cardiovascular risk assessment and management program in the world. We assessed the effect of this program on modelled risk of cardiovascular disease, individual risk factors for cardiovascular disease, prescribing of relevant medications and diagnosis of vascular disease.
  
  
  METHODS
  We obtained retrospective electronic medical records for a randomly selected sample of 138 788 patients aged 40-74 years registered with 462 English general practices participating in the Clinical Practice Research Datalink between 2009 and 2013. We used a quasi-experimental design of difference-indifferences matching analysis to compare changes in outcomes between Health Check attendees and nonattendees, with a median follow-up time of 2 years.
  
  
  RESULTS
  Overall, 21.4% of the eligible population attended a Health Check. After matching (n = 29 672 in each group), attendees had a significant absolute reduction in modelled risk for cardiovascular disease (-0.21%, 95% confidence interval [CI] -0.24% to -0.19%) and individual risk factors: systolic blood pressure (-2.51 mm Hg, 95% CI -2.77 to -2.25 mm Hg), diastolic blood pressure (-1.46 mm Hg, 95% CI -1.62 to -1.29 mm Hg), body mass index (-0.27, 95% CI -0.34 to -0.20) and total cholesterol (-0.15 mmol/L, 95% CI -0.18 to -0.13 mmol/L). Statins were prescribed for 39.9% of attendees who were at high risk for cardiovascular disease. The program resulted in significantly more diagnoses of selected vascular diseases among attendees, with the largest increases for hypertension (2.99%) and type 2 diabetes mellitus (1.31%).
  
  
  CONCLUSIONS
  The National Health Service Health Check program had statistically significant but clinically modest impacts on modelled risk for cardiovascular disease and individual risk factors, although diagnosis of vascular disease increased. Overall program performance was substantially below national and international targets, which highlights the need for careful planning, monitoring and evaluation of similar initiatives internationally.
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK chu-mei.chang@imperial.ac.uk.
authors.forename: Kiara Chu-Mei
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Eszter P
authors.initials: EP
authors.lastname: Vamos
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Soljak
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Desmond
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health (Chang, Lee, Vamos, Soljak, Majeed, Millet) and Division of Diabetes, Endocrinology and Metabolism (Johnston), Department of Medicine, Imperial College, London, UK; Saw Swee Hock School of Public Health (Lee), National University of Singapore, Singapore; Diabetes Research Centre (Khunti), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013222:State Medicine
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol