Purpose: To critically appraise recommendations on cardiovascular risk assessment in order to guide selection of screening interventions for a cardiovascular health check.
Method: Guidelines in the English language published between January 2003 and May 2009 were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National Guideline Clearinghouse, the National Library for Health, CMA Infobase, and the International Guideline Database. Guidelines developed on behalf of professional organizations from Western countries, containing recommendations on cardiovascular risk assessment for the apparently healthy population were included. Titles and abstracts were assessed by 2 independent reviewers. Rigour of guideline development was assessed by 2 independent reviewers. One reviewer performed a full extraction of details of the recommendations and information on conflicts of interest.
Result: Of 1984 titles identified in our original search, 27 guidelines met our criteria. Sixteen of 27 guidelines reported information on conflicts of interest and 18 showed considerable rigour of development, providing 20 recommendations. Recommendations on total cardiovascular risk (n=7), dyslipidemia (n=3), hypertension (n=2) and dysglycemia (n=8) were summarized qualitatively. Recommendations on total cardiovascular risk and dyslipidemia included prediction models integrating multiple major risk factors, whereas recommendations on hypertension and dysglycemia primarily focused on single risk factors. Differences were found among recommended target groups, treatment thresholds and screening tests in addition to major risk factors. No firm recommendations were made for screening periodicities. Dysglycemia guidelines disagreed on the value of screening in comparable populations.
Conclusion: Differences among guidelines imply important variation in allocation of preventive interventions. Only recommendations from rigorously developed guidelines with unambiguous declarations about conflict of interest should be used for organizing cardiovascular health checks.
Candidate for the Lee B. Lusted Student Prize Competition