October 2022
Population-based cardiovascular screening in older men shows no mortality benefit

Men ages 65 to 74 years offered comprehensive screening with intensive follow up had similar mortality as controls.

Could broad population-based screening for cardiovascular disease – using an array of diagnostic tests – lower mortality? To find out, Danish investigators randomised about 47,000 men (age range, 65 to 74 years) selected from a national registry to a group invited to participate in comprehensive CVD screening or to a control group. Screening included coronary artery calcium scoring, computed tomography to identify aortic and iliac aneurysms, electro- cardiography, ankle-brachial blood pressures and glucose and lipid profile measurements. Positive results were provided to patients and their primary care physicians with recommendations for follow up or referral as needed.

About two-thirds of the invited group actually underwent screening. In an intention-to-treat analysis over a median follow up of nearly six years, all- cause mortality (the primary outcome) was not significantly different in the invited and control groups (12.6% and 13.1%, respectively). In secondary analyses, a slightly lower incidence of stroke in the invited group (a difference of one stroke per 1000 person-years) barely achieved statistical significance, but there were no differences for any other outcomes. Harms and safety outcomes were similar in both groups. 

Comment: The underlying premise of this research is that individualised case-finding in primary care practice – with selective ordering of tests like those used in this study – misses opportunities to improve cardiovascular health. While that premise might have some merit, the population-based intervention examined here does not seem to improve upon usual care – at least in Denmark.
Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Lindholt JS, et al. Five-year outcomes of the Danish Cardiovascular Screening (DANCA-VAS) trial. N Engl J Med 2022 Aug 27; e-pub (https://www.nejm.org/doi/10.1056/NEJMoa2208681).

This summary is taken from the following Journal Watch title: General Medicine.

N Engl J Med