Cardiovascular screening does not significantly improve mortality: NEJM

Denmark: A new study published in The New England Journal of Medicine found no significant reduction in all-cause mortality in men aged 65 to 74 after being invited to undergo comprehensive cardiovascular screening for more than five years.

Limited data suggest an advantage of population-based screening for cardiovascular disease in terms of mortality risk. Jes S. Lindholt and his team conducted a population-based, randomized, controlled, parallel-group study in men aged 65 to 74 years living in 15 municipalities in Denmark.

Participants were randomly assigned for an asymptomatic cardiovascular disease he screened (invited group) or unscreened (control group) in a 1:2 ratio. Randomization was based on computer-generated random numbers and stratified by the community. Only the control group was unaware of the assignment to the experimental group.

Screening includes determination of coronary artery calcium score, contrast-free ECG-guided computed tomography to detect aneurysms and atrial fibrillation, ankle-brachial blood pressure measurement to detect peripheral artery disease and hypertension, true A blood sample was included to detect diabetes and hypercholesterolemia. The primary endpoint was death from any cause.

The main results of this study:

1. A total of 46,611 participants were randomized.

2. After excluding 85 men who died or emigrated before being invited to screen, 16,736 men belonged to the invited group and 29,790 men to the control group.

3. Of the men in the invited group, 10,471 (62.6%) were screened.

4. In the intention-to-treat analysis, 2106 (12.6%) men in the invitation group and 3915 (13.1%) men in the control group died after a median follow-up of 5.6 years.

5. The hazard ratio for stroke in the invited group compared to the control group was 0.93. 0.91 for myocardial infarction; 0.95 for aortic dissection; 0.81 for aortic rupture.

6. There were no significant differences between groups for safety outcomes.

In conclusion, the findings of this study don't suggest any significant changes in all-cause mortality after comprehensive cardiovascular screening between 65 to 74 years old.

Reference: 

Lindholt, J. S., Søgaard, R., Rasmussen, L. M., Mejldal, A., Lambrechtsen, J., Steffensen, F. H., Frost, L., Egstrup, K., Urbonaviciene, G., Busk, M., & Diederichsen, A. C. P. (2022). Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2208681