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First degree relatives of patients with coronary heart disease are at higher risk than the general population.1 Screening first degree relatives would be an improvement on unselected screening. However, family history is only one of several risk factors for cardiovascular disease. Selecting patients for screening on the basis of multiple risk factors is better than selecting patients on the basis of one risk factor. For most patients, many risk factors are known. All patients have an electronic record of their age and sex. Most patients have an electronic record of their smoking status and blood pressure, and some have a cholesterol measurement. If diagnosed, patients with diabetes have an electronic record of this diagnosis. If they have a family history of premature coronary heart disease, some patients have a record of this fact.
Earlier in 2007 I collected electronic data from three large general practices. Of 19552 patients aged 35 and older, 35% had full risk factor information, and 76% lacked only a cholesterol measurement. Of these, 2.2% (437) were aged 35-74, untreated but at a greater than 20% 10 year cardiovascular risk and hence eligible for treatment. When patients whose cholesterol concentrations were not known were included, 6.7% (1307) were untreated patients at high risk. Only 14% (181) of these patients had a record of a family history of premature coronary heart disease.
These figures are consistent with the results from similar data extraction exercises in eight different practices at various times over the past few years.
Since patients over 35 are about half the practice population, this means that in a typical practice about 3-4% of the population are currently untreated but have recorded risk factors indicating they are at high risk. These patients are identifiable by searching the practice database, without the need to wait until their relatives present to secondary care with heart disease.
Competing interests: None declared.