Reviewer: : Dr. Uğur Ozan Demirhan

Name of the Study: Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial

Published Congress: ESC 2022

Link : https://www.escardio.org/The-ESC/Press-Office/Press-releases/Cardiovascular-screening-may-reduce-risk-of-death-and-cardiovascular-disease

Background:

Despite remarkable reductions in mortality from cardiovascular disease, it remains the leading cause of death. More than half of cardiovascular disease is avoidable, meaning that successful prevention has a huge potential to improve public health.

Objective:

DANCAVAS investigated whether screening, including imaging, for seven cardiovascular conditions, and treatment if indicated, could prevent death and cardiovascular disease

Methods:

Between September 2014 and September 2017 years, the researchers identified all men aged 65 to 74 years within 15 municipalities in Denmark. The participants were randomly assigned in a 1:2 ratio to undergo screening (the invited group) or not to undergo screening (the control group) for subclinical cardiovascular disease. Screening included non-contrast electrocardiography-gated computed tomography to determine the coronary-artery calcium score and to detect aneurysms and atrial fibrillation, ankle–brachial blood-pressure measurements to detect peripheral artery disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolemia. The primary outcome was death from any cause. The secondary outcomes were the following: stroke, myocardial infarction, amputation due to vascular disease, aortic dissection, aortic rupture, and cost-effectiveness.

Results:

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 non-significant 5% relative risk reduction. There was only an 11% decreased risk in those aged 65 to 69 years in the subgroup analysis. Regarding secondary outcomes, 1,169 (7.0%) men in the intervention group had a stroke compared with 2,228 (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; 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).

Conclusion:

In this population-based, randomized trial, older men who were invited to undergo comprehensive cardiovascular screening did not have a significantly lower risk of death than a control group. However, the intervention reduced the risk of a composite endpoint of death, stroke or myocardial infarction in the overall population with an even greater reduction in those aged 65 to 69 years.

Interpretations:

This trial reveals that a substantial reduction in the combined endpoint of death, stroke or myocardial infarction in elderly men by comprehensive cardiovascular screening. The results point quite firmly at a screening target age below 70 years.