Cardiovascular Screening In Men Aged 60 To 64 Years Does Not Reduce All-cause Mortality

An invitation to be a broad screening introspection for nan early signs of cardiovascular illness (CVD) did not trim all-cause decease among men aged 60 to 64 years, according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

It has been estimated that 80% of cardiac events and strokes are preventable, astir half of these done early discovery and intervention. Population screening is 1 attack to place individuals pinch early signs of CVD, but location is constricted grounds that it provides benefits successful position of reducing deaths.

We person antecedently shown successful nan population-based DANCAVAS 1 proceedings that while inviting men aged 65 to 74 years to acquisition cardiovascular screening did not importantly trim nan incidence of decease overall, location appeared to beryllium a simplification successful a subgroup of men aged 65 to 69 years. We designed nan DANCAVAS 2 proceedings to analyse nan effects of population-based screening successful moreover younger men - aged betwixt 60 and 64 years - to spot if decease could beryllium importantly reduced."

Professor Axel Cosmus Pyndt Diederichsen, Principal Investigator of nan DANCAVAS 2 trial, Odense University Hospital, Odense, Denmark

The population-based, parallel-group, randomized controlled DANCAVAS 2 proceedings included each men aged 60-64 years surviving successful 18 municipalities successful Denmark from August 2017 to November 2018 without immoderate removal criteria. They were randomized 1:4 to person an invitation to be screening for subclinical CVD (the invited group) aliases not to person an invitation for screening (the power group). Participants successful nan power group were blinded and were not alert of nan trial. Intention-to-treat analyses were performed which compared power vs. each invited participants, whether aliases not they attended screening.

Screening included non-contrast ECG-gated computed tomography (CT) to find nan coronary-artery calcium people and to observe aneurysms and atrial fibrillation, ankle-brachial blood-pressure measurements to observe peripheral artery illness and hypertension, and a humor sample to observe glucosuria mellitus and hypercholesterolaemia. Statins and/or an antithrombotic supplier (aspirin aliases clopidogrel) were prescribed based connected nan results of nan screening tests. The superior result was decease from immoderate cause.

In total, 31,268 participants were randomized: 25,322 to nan power limb and 5,946 to nan invited arm, of whom 3,720 attended and were screened (62.6%). In total, 33.5% of nan invited group initiated an antithrombotic supplier compared pinch 15.9% successful nan power group, while nan initiation complaint of statins was 44.3% and 30.3%, respectively.

In intention-to-treat analyses, aft a median follow-up of 7.0 years, 9.3% of men successful nan invited group and 9.9% men successful nan power group had died (hazard ratio [HR] 0.94; 95% assurance interval [CI] 0.86 to 1.03; p=0.169).

Major adverse cardiovascular events (CVD-related death, changeable aliases acute myocardial infarction) occurred successful 10.2% of participants successful nan invited group vs. 10.6% successful nan power group (HR 0.96; 95% CI 0.88 to 1.04), while 1.8% of participants successful some groups knowledgeable awesome adverse little limb events (HR 1.01; 95% CI 0.82 to 1.24). CVD-related decease occurred successful 2.1% of participants successful nan invited group vs. 2.3% successful nan power group (HR 0.92; 95% CI 0.76 to 1.11).

There was a importantly higher incidence successful nan invited group vs. power group of terrible bleeding (6.0% vs. 5.1%; HR 1.18; 95% CI 1.05 to 1.32; p=0.007). This included intracranial bleeding (1.4% vs. 1.1%; HR 1.23; 95% CI 0.96 to 1.58; p=0.097) and gastrointestinal bleeding (4.8% vs. 4.1%; HR 1.18; 95% CI 1.03 to 1.34; p=0.014), respectively.

In station hoc per-protocol analyses, attending screening reduced mortality by 17% (95% CI 2% to 29%; p=0.029), while location was nary important quality successful awesome adverse cardiovascular events.

Putting nan findings into context, Professor Diederichsen noted: "The non-significant 6% simplification successful decease successful men aged 60-64 years successful nan DANCAVAS 2 proceedings was little than nan 11% simplification observed successful nan subgroup of men aged 65-69 years successful nan DANCAVAS 1 trial.3 The results whitethorn person been affected by those who were invited but did not be screening. We could besides estimate that screening somewhat older individuals - astir 67 years aged - whitethorn beryllium much beneficial. An important study was nan summation successful terrible bleeding seen successful nan invited group, which was apt owed to higher aspirin intake and indicates that aspirin should beryllium utilized very selectively for superior prevention successful men aged 60-64 years, moreover successful patients pinch coronary calcifications." Regarding adjacent steps, he concluded: "We included only men successful DANCAVAS 2 because of a higher prevalence of screening findings successful an earlier aviator study, but early population-based studies are warranted successful women."