Table 3

Details of participants

Author and dateStudy designInclusion criteriaMethod of recruitment/randomisationn (% of those eligible)Age (years)Gender (male)Baseline CVD risk score
Asimakopoulou (2008)20Before-after studyPatients with type 2 diabetes free from cardiovascular, cerebrovascular or psychiatric comorbidity and able to understand EnglishInspection of medical records then letter of invitation and randomisation to 1,5 or 10-year risk95 (66%)Mean 64 (range 42–72)44%Mean CHD 25% Mean stroke 15%
Avis (1989)21RCTAdults 25–65 years with no history of CHD, diabetes or hypertensionRandom digit dialling then randomisation to one of 4 risk appraisal toolsControl: 89
Intervention: 542
NANAAbove average risk (risk ratio over 1.25): 36%
Christensen (1995)22Before-after study40–49-year-old menRandomly selected from Public Health Insurance register then invited by GPLow / moderate risk: 150 (81%) High risk 123 (73%)40–49100%NA
Christensen (2004)23RCT30–49 years old registered with local GPLetter of invitation to random sample of those registered with local practice then randomisation into control and 2 intervention groups (combined for analysis)Control: 501 (75%)
Intervention: 905 (68%)
NANAHigh risk (score>10): 11.4%
Connelly (1998)24Before-after studyMen aged 45–69 years with no obvious contraindications to antithrombotic therapy, no history of peptic ulceration or previous history of MI, stroke or serious psychiatric disorderSearch of medication records then letters of invitationBaseline: 5772 (99%)
10 days: 4917 (85%)
3 months: 4244 (74%)
45–69100%High risk (highest quintile): 18.4%
Hanlon (1995)25RCTWorkers at two work sites not working permanent night shifts, taking part in another coronary intervention or taking lipid-lowering medicationRandom selection of workers then computer-generated randomisationControl: 229 (78%) (HE only) and 226 (76%) (HE and feedback on cholesterol)
Intervention: 214 (75%) (HE and risk) and 199 (76%) (HE, feedback on cholesterol and risk)
Control: 20–65 Intervention: 20–65NANA
Hussein (2008)26Before-after studyPeople with complete data available and no history of CVD eventsSelf-selection at 2 events of free stroke risk screening as part of a community health fair146 (80%)Mean 47±1536%High risk (5%): 23.97%
Paterson (2002)27Before-after studyAge 30–74 years with measurements for blood pressure, smoking status, total and high-density lipoprotein cholesterol and free from cardiovascular diseaseFirst 20 physicians who responded to letter of invitation. Physicians then enrolled 2 patients who met the study criteria and for whom they would be likely to use Heartcheck under normal practice conditions37 (92.5%)50±10.768%Mean (SD): 10.8% (6.9)
Persell (2013)28RCTPrimary care physicians at an academic medical centre and patients aged 40–79 years without history of CVD, DM or PAD, not taking lipid-lowering medication who had 2 or more clinic visits in the preceding 2 years and LDL cholesterol test in previous 5 years with most recent LDL ≥100 mg/dL and 10-year FRS >20% or LDL ≥130 mg/dL and FRS 10–20% or LDL ≥160 mg/dL and FRS 5–10%Medical record search then block randomisation at the level of the practice using random number generatorControl: 217
Intervention: 218 (93.6% across both control and intervention groups)
Control: 60.1±9.2
Intervention: 61.3±9.4
Control: 77% Intervention: 77.5%Mean (SD): 14% (6.5)
Price (2011)29RCTPatients with CVD risk ≥20%, able to read and write English, not known to have CVD or a physical disability or other condition reducing the ability to walkEligible patients mailed written invitation and then factorial computerised randomisationControl: 91
Intervention: 94 (16% across both control and intervention groups)
Control: median (IQR) 62.4 (56.0–65.9); Intervention: median (IQR) 62.3 (54.2–66.2)Control: 71% Intervention: 64%Median (IQR) men: 48% (34–60); women 31% (22–43)
Qureshi (2012)30Before-after studyAged 30–65 years requesting a CVD risk assessment by their family physician without previous diagnosis of diabetes or CHD, stroke or PAD and not already receiving lipid-lowering medications or excluded by their physicians for psychological or social reasonsUsual practiceControl: 353 (92.9%)
Intervention: 305 (80.3%)
Median 52 (45–58)39%High risk (>20%): 11.4%
Bucher (2010)31RCTPatients registered at the centres, not pregnant, aged 18 or older with continuous cART for 90 days prior to baseline and with complete data on CHD risk factors at baselinePhysicians randomised in strata according to patient volume and type of settingControl physicians: 57 (71%) Control patients: 1682 (84%) Intervention physicians: 60 (71%) Intervention patients: 1634 (78%)Control: median 44 (39–50) Intervention: median 44 (39–51)Control: 64% Intervention: 68%High risk (>20%): 3%
Hall (2003)32(R)CTPatients 35–75 years with type 2 diabetes and no history of CVD or renal disease attending a hospital outpatient clinicConsecutive recruitment of patients with alternate allocation to experimental and control group with doctors unaware of projectControl: 161
Intervention: 162
NANAHigh risk (>20%): 52%
Hanon (2000)33RCTAdults 18–75 years with BP >140/90 without severe hypertension, secondary hypertension, heart disease, CVD, renal, pulmonary, hepatic disease or significant psychiatric or other serious illness, diabetes, pregnancy or of reproductive age without effective contraceptionRecruited during usual care then randomised into 2 groups whether primary care physician had been told CVD riskControl: 712
Intervention: 556
Control: Mean 60±10 Intervention: Mean 60±10Control: 54% Intervention: 54%Mean (SD): 25.4% (12.0)
Grover (2007)34RCTPatients with diabetes or 10-year risk > 30% with moderate cholesterol, 10-year risk 20–30% with high cholesterol or 10-year risk 10–20% with very high cholesterol with no hypersensitivity to statins, risk of pregnancy, breastfeeding, active liver disease, raised CK or triglycerides, a history of pancreatitis or significant renal insufficiency*Identified from office medical records or prebooked clinic appointments then randomisation stratified by risk levelControl: 1193
Intervention: 1163 (initial 98% recruitment)
NANAMean (SD): 17.8% (7.5)
Grover (2009)35RCTAs for Grover 200734Identified from office medical records or pre-booked clinic appointments then randomisation stratified by risk levelControl: 143
Intervention: 166 (initial 98% recruitment)
NANAMean (SD): 17.8% (7.5)
Lowensteyn (1998)36RCTInterested primary care physicians around study centre. Patients 30–74 years without history of CVD in whom clinicians thoughts a risk profile would be clinically usefulPractices around study centre with block randomisation at the level of primary care practice according to presence or absence of medical school. Patients selected by physiciansControl physicians:32 (39%)
Control patients: 176
Intervention physicians: 97 (57%)
Intervention patients: 782
Control: 50.7±11.3
Intervention: 50.0±10.8
Control: 64.8% Intervention: 64.8%Mean (SD): 10.5% (9.3)
  • *Full criteria for inclusion were: 10-year risk >30% with LDL ≥97 mg/dL or TC:HDL ratio ≥4 or; 10-year risk 20–30% with LDL ≥116 mg/dL or a TC:HDL ratio ≥5 or; 10-year risk 10–20% with HDL-C ≥155 mg/dL or TC:HDL-C ratio ≥6; no hypersensitivity to statins, risk of pregnancy, breast feeding, active liver disease or elevated AST or ALT levels (>3 times normal), CK ≥5 times normal, elevated TGs (>939 mg/dL), a history of pancreatitis or significant renal insufficiency.

  • ALT, alanine transaminase; AST, aspartate transaminase; cART, combination antiretroviral therapy; CHD, coronary heart disease; CK, creatine kinase; CVD, cardiovascular disease; DM, diabetes mellitus; FRS, Framingham risk score; GP, general practitioner; HDL, high density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; MI, myocardial infarction; NA, not available; PAD, peripheral arterial disease; RCT, randomised controlled trial; TC, total cholesterol; TG, triglyceride.