Five-year results of the Danish Cardiovascular Screening Trial (DANCAVAS)

Summary

Background

Limited data suggest a benefit of population-based cardiovascular disease screening with respect to risk of death.

Methods

We performed a population-based, parallel-group, randomized controlled trial involving men aged 65-74 living in 15 Danish municipalities. Participants were randomly assigned in a 1:2 ratio to be screened (the invited group) or not screened (the control group) for subclinical cardiovascular disease. Randomization was based on computer-generated random numbers stratified by municipality. Only the control group was unaware of the test group’s assignments. Screening included CT scan with non-contrast electrocardiography to determine coronary artery calcium score and to detect aneurysms and atrial fibrillation, ankle-arm blood pressure measurements to detect peripheral arterial disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolemia. The primary outcome was death from any cause.

Results

A total of 46,611 participants were randomized. After excluding 85 men who died or emigrated before being invited for screening, there were 16,736 men in the invited group and 29,790 men in the control group; 10,471 of the men in the guest group were screened (62.6%). In intention-to-treat analyses, after a median follow-up of 5.6 years, 2106 men (12.6%) in the invited group and 3915 men (13.1%) in the control group had died (relative risk , 0.95, 95% confidence interval [CI], 0.90 to 1.00; p=0.06). The risk ratio of stroke in the invited group, compared to the control group, was 0.93 (95% CI, 0.86 to 0.99); for myocardial infarction, 0.91 (95% CI, 0.81 to 1.03); for aortic dissection, 0.95 (95% CI, 0.61 to 1.49); and for aortic rupture, 0.81 (95% CI, 0.49 to 1.35). There were no significant differences between groups in safety outcomes.

conclusion

After more than 5 years, invitation to complete cardiovascular screening did not significantly reduce the incidence of death from all causes in men aged 65 to 74 years. (Funded by Danish Southern Region and others; DANCAVAS ISRCTN register number, ISRCTN12157806.)

Elna M. Lemons