A randomized trial of more than 45,000 men has suggested that cardiovascular screening that includes heart imaging, blood pressure measurement and blood tests, plus treatment if needed, can reduce the risk of death, heart attack and stroke in people aged 65 to 69. The state-of-the-art research is being presented today in a hotline session at the ESC 2022 Congress. The trial did not meet the primary outcome of reducing mortality in men aged 65 to 74.
Despite the remarkable reduction in mortality from cardiovascular disease, it remains the leading cause of death. More than half of cardiovascular disease is preventable, which means that successful prevention has great 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 the Odense University Hospital, Denmark
Between September 2014 and September 2017, the researchers identified all men between the ages of 65 and 74 within 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 usual Danish practice of no screening (control group; 29,790 men). The average age was 68.8 years.
The screening and intervention program included: 1) non-contrast cardiac and trunk computed tomography to detect coronary artery calcification score above the sex- and age-specific mean, aortic and iliac aneurysms, and atrial fibrillation; 2) brachial and ankle blood pressure in 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 drugs 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 an average 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, which corresponds to a non-significant reduction in the relative risk of 5% (risk 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 and older (HR 1, 01; 95% CI 0.94-1.09; p=0.747), but an 11% decreased risk in people 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 total population (p=0.016), with an even greater reduction of 11 % in people aged 65 to 69. (p=0.007).
Regarding secondary outcomes, 1169 (7.0%) men in the intervention group had a stroke compared with 2228 (7.5%) in the control group (HR 0.93; 95% CI 0.86- 0.99; p=0.035). There were no differences between the two groups in myocardial infarction (HR 0.91; CI 95% 0.81-1.03; p=0.134), amputation due to vascular disease (HR 1.05; CI 95% 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; CI 95% 2.97-3.28; p<0.001) and lipid-lowering agents (20.7% versus 9, 0%; HR 2.54; 95% CI-2.64; p<0.001) <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 with the control group (1.2%; HR 1.29; 95% CI 1.07–1, 48; p=0.006).
Professor Diederichsen said: “We observed a substantial reduction in the combined end point of death, stroke or myocardial infarction in older men using comprehensive cardiovascular screening. Our results strongly point to a target age for screening below 70 years “.
Source:
European Society of Cardiology (ESC)