BACKGROUND AND AIMS: Limited data suggest a benefit of population-based screening for cardiovascular disease (CVD) with respect to mortality.
METHODS: A population-based, parallel-randomized controlled trial of Danish men aged 60-64 years randomized 1:4 to invitation to screening for subclinical CVD or no invitation (control group) were performed. Allocation was based on computer-generated random numbers and stratified on municipality. Only the control group was blinded. The screening included coronary artery calcification score, aneurysms, atrial fibrillation, peripheral arterial disease, hypertension, diabetes mellitus and hypercholesterolemia. Intervention included statin, aspirin and surveillance. The primary outcome was all-cause mortality.
RESULTS: 31,268 participants were randomized; 25,322 men in the control arm and 5,946 in the invited arm, of whom 3,720 attended and were screened (62·6%). In intention-to-treat analyses, after a median follow-up of 7·0 years, 555 (9.3%) men in the intervention group and 2,509 (9·9%) men in the control group had died; hazard ratio (HR) = 0.94 (95% CI: 0·86;1·03), p=0·169.Major adverse cardiovascular events (MACE) were registered in 606 (10·2%) versus 2,682 (10·6%) (HR=0·96 [95% CI 0·88;1.04]; p=0·319).Severe bleedings were significantly more common in the invited-to-screening group (6·0% versus 5·1%; HR=1·18 [95% CI 1·05;1·32]; p=0·007). This included intracranial (HR=1·23 (95% CI 0·96;1·58); p=0·097) and gastrointestinal bleedings (HR=1·18; (95% CI 1·03;1·34) p=0·014), respectively.
CONCLUSIONS: Invitation to a comprehensive CT-based screening for subclinical CVD did not decrease death over 7 years among men aged 60-64 years but did increase severe bleeding. Because the trial was powered for events over 10 years, further follow-up is needed. Clinicaltrials.gov number: NCT03946410.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Public Health |  |
| Hospital Doctor/Hospitalists |  |
| Internal Medicine | |
While not applicable to hospitalists, this article may be of significant interest to my primary care colleagues. Nevertheless, the results are complex, with a significant discrepancy between the intention-to-treat and per-protocol analyses that may be amenable to educational intervention. It will be fascinating to see how guidelines evolve in response to this ambiguity.