Imaging-based community CV screening shows possible reduction in death among older men
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In the DANCAVAS trial, an invitation for comprehensive imaging-based CV screening did not significantly lower the incidence of all-cause death after 5 years among men aged 65 to 74 years, but results suggest a benefit in men younger than 70.
“A substantial risk reduction in death of all causes and cardiovascular diseases may be possible in elderly men by comprehensive imaging-based cardiovascular screening. The results point firmly at a target group below 70 years,” Axel Diederichsen, MD, PhD, with the department of cardiology at Odense University Hospital, Denmark, said in a press conference during the European Society of Cardiology Congress.
The population-based DANCAVAS trial randomly assigned on a 1:2 basis more than 46,600 men aged 65 to 74 years in Denmark. Men were randomly invited to undergo screening for subclinical CVD (n = 16,736) or no screening (control group: n = 29,790). Sixty-two percent of men in the invited group were ultimately screened, which involved noncontrast electrocardiography-gated CT to determine a coronary artery calcium score and to detect aneurysms and atrial fibrillation; ankle-brachial BP measurements to detect hypertension and peripheral artery disease; and blood samples to detect diabetes and hypercholesterolemia.
After a median follow-up of 5.6 years, an invitation for screening did not significantly reduce the primary outcome of death from any cause, which occurred in 12.6% of men in the invited group and 13.1% in the control group (HR = 0.95; 95% CI, 0.9-1; P = .06). The cumulative incidence of death at 5 years was 10.6% for men who underwent screening and 10.9% among those who did not, according to the findings, which were simultaneously published in The New England Journal of Medicine.
In other results, the combined risk for death from any cause, stroke and MI was decreased by 7% during follow-up (HR = 0.93; 95% CI, 0.89-0.97; P = .016). Additionally, the researchers reported decreased risk in the invited group vs. the control group for stroke (HR = 0.93; 95% CI, 0.86-0.99), MI (HR = 0.91; 95% CI, 0.81-1.03), aortic dissection (HR = 0.95; 95% CI, 0.61-1.49) and aortic rupture (HR = 0.81; 95% CI, 0.49-1.35).
In a prespecified subgroup analysis, there was a suggestion of a difference according to age. Death from any cause was decreased by 11% in men aged 65 to 69 years (HR = 0.89; 95% CI, 0.83-0.96; P = .004).
“This is a never-before-seen reduction in a community-based screening trial,” Diederichsen said.
The researchers reported no difference in safety outcomes between the two groups.
As part of the screening process, preventive medication was initiated for those with abnormal findings. Men in the invited group had higher initiation of antiplatelet and lipid-lowering agents during follow-up.
Additionally, screening was cheaper than recommended cancer screening programs, Diederichsen said.
The researchers noted that the trial is limited by its inclusion of only men and only individuals living in Denmark.
“In my opinion, I think that use of imaging might be a game changer in the prevention of cardiovascular diseases,” Diederichsen said.
Reference:
Perspective
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Dipti Itchhaporia, MD, MACC, FESC, FAHA
The question being asked in this trial — whether doing a screening program for CVD can decrease the risk for CV mortality — is an important question. I think all-cause mortality was very ambitious as a primary outcome. When you look at the results, a few things come up. One is that that the prespecified subgroup analysis did show that the 65- to 69-year-olds benefited the most in terms of all-cause mortality, rather than the older population. Several questions arise: Did the investigators choose the right population to target this outcome? The trial enrolled only men; we don’t have data on women. But this study is being done. Also, were these all the appropriate screening tests?
The general thinking from other trials has been that some sort of CV screening program is helpful to decrease CV risk. This study did not show this but does not mean that a CV screening may not work. We need more data. The take-home is that there was a signal for the younger patients aged 65 to 69 years so, to me, there is an opportunity to continue to ask these questions and consider different ways to look at this issue further. I don’t think we stop here.
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Diederichsen A, et al. Hot Line 2. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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