Screening for future cardiovascular disease using age alone compared with multiple risk factors and age

Area of Science:

• Cardiology
• Preventive Medicine
• Public Health

Background:

• Cardiovascular disease (CVD) risk assessment commonly uses factors like blood pressure, serum cholesterol, and age.
• The comparative effectiveness of age-based screening versus multi-risk factor screening for future CVD events remains unclear.

Purpose of the Study:

• To compare the performance and cost-effectiveness of age-only screening versus Framingham risk assessment for predicting future cardiovascular disease events.

Main Methods:

• A hypothetical cohort of 500,000 individuals aged 0-89 years was simulated.
• Ten-year CVD risk was estimated using Framingham risk equations.
• Screening performance metrics (detection rate, false-positive rate) and cost-effectiveness (cost per CVD-free life year gained) were calculated for both age-only and Framingham screening strategies.

Main Results:

• Age screening (cut-off 55 years) detected 86% of CVD events with a 24% false-positive rate.
• Framingham screening achieved the same detection rate with a 21% false-positive rate.
• The cost per CVD-free life year gained was £2,000 for age screening and £2,200 for Framingham screening.

Conclusions:

• Age screening demonstrates comparable performance and cost-effectiveness to Framingham screening for CVD events.
• Age screening is simpler, avoiding blood tests and medical examinations.
• The advantages of age screening suggest its consideration over multi-risk factor screening for preventing heart attack and stroke.