A randomized trial of more than 45,000 men suggested that cardiovascular screening, which includes cardiac imaging, blood pressure measurement, and blood tests, plus treatment if needed, may reduce the risk of death, heart attack, and stroke in people from 65 to 69 years old. The breaking research is being presented today at a Hot Line session at the ESC 2022 Congress. The trial did not meet the primary outcome of reduced mortality in men aged 65 to 74 years.
Despite notable reductions in cardiovascular disease mortality, it remains the leading cause of death. More than half of cardiovascular diseases are preventable, which means that successful prevention has enormous potential to improve public health. DANCAVAS investigated whether screening, including imaging, for seven cardiovascular conditions and treatment, if indicated, could prevent death and cardiovascular disease.”
Professor Axel Diederichsen of Odense University Hospital, Denmark
Between September 2014 and September 2017, the researchers identified all men aged 65 to 74 in 15 municipalities in the southern and central regions of Denmark. A total of 46,526 men were randomly assigned in a 1:2 ratio to screening and intervention (16,736 men), or to the Danish standard practice of no screening (control group; 29,790 men). The average age was 68.8 years.
The screening and intervention program included: 1) a cardiac and truncal noncontrast computed tomography scan to detect a coronary artery calcification score above the sex- and age-specific median, aortic and iliac aneurysms, and atrial fibrillation; 2) brachial and ankle blood pressure in both arms and legs to diagnose peripheral arterial disease; and 3) blood tests to identify high cholesterol and diabetes. In case of abnormal findings, prophylactic treatments including medication and aortic surgery were offered. Information on medication, surgery, cardiovascular disease, and death after five years of follow-up was obtained from national registries.
The primary outcome was all-cause mortality. Secondary outcomes were stroke, myocardial infarction, amputation for vascular disease, aortic dissection, and aortic rupture. Results were compared between the two groups using the intention-to-treat principle. During a median follow-up of 5.6 years, 2,106 (12.6%) men in the intervention group and 3,915 (13.1%) men in the control group died, corresponding to a relative risk reduction not significant 5% (hazard ratio [HR] 0.95; 95% confidence interval [CI] 0.90-1.00; p=0.062). The number needed to invite screening to prevent one death was 155. When the effect of the intervention on mortality was analyzed by age, there was no difference between men aged 70 years or older (HR 1.01; 95% CI 0.94-1.09; p=0.747), but the risk decreased by 11% in those aged 65 to 69 years (HR 0.89; 95% CI 0.83-0.96; p=0.004).
In a post hoc analysis, the intervention reduced the risk of a composite endpoint of death, stroke, or myocardial infarction by 7% in the general population (p = 0.016), with an even greater reduction of 11% in people from 65 to 69 years old (p=0.007).
Regarding secondary outcomes, 1169 (7.0%) men in the intervention group had a stroke compared to 2228 (7.5%) in the control group (HR 0.93, 95% CI 0.86 -0.99, p=0.035). There were no differences between both groups in myocardial infarction (HR 0.91; 95% CI 0.81-1.03; p=0.134), amputation due to vascular disease (HR 1.05; 95% CI 0.80-1 .38; p=0.711), aortic dissection (HR 0.95; 95% CI 0.61-1.49; p=0.827), or aortic rupture (HR 0.81; 95% CI 0.49-1, 35, p=0.420).
Regarding prophylactic treatments, antithrombotic agents (22.9% versus 8.3%; HR 3.12; 95% CI 2.97-3.28; p<0.001) and lipid-lowering agents (20.7% versus 9.0 %; HR 2.54; 95% CI 2.42-2.67; p < 0.001) were prescribed more frequently in the intervention group compared to the control group. There were no differences in the prescription of anticoagulants, antihypertensives or antidiabetics. Elective aortic aneurysm repair was more common in the intervention group (1.5%) compared to the control group (1.2%; HR 1.29, 95% CI: 1.07-1.48 ; p=0.006).
Professor Diederichsen said: “We saw a substantial reduction in the combined endpoint of death, stroke or myocardial infarction in older men using a comprehensive cardiovascular assessment. Our results point quite strongly to a target age of screening below 70 years”.
European Society of Cardiology (ESC)
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