Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium...

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Screening

Background:

• Early detection of high cardiovascular disease (CVD) risk through screening and subsequent preventive treatment can decrease related morbidity and mortality.
• The Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA) trial is a population-based randomized controlled screening study.
• ROBINSCA evaluates the effectiveness of CVD screening using either the Systematic COronary Risk Evaluation (SCORE) model or coronary artery calcium (CAC) scoring in asymptomatic individuals.

Purpose of the Study:

• To describe the distribution of CVD risk and subsequent treatment recommendations within the ROBINSCA trial.
• To compare the risk stratification and treatment indications between SCORE and CAC scoring methods.

Main Methods:

• Asymptomatic individuals were randomized into two screening arms: Arm A (n=14,478) using SCORE, and Arm B (n=14,450) using CAC scoring.
• Preventive treatment decisions were primarily based on current Dutch guidelines.
• Risk and treatment differences between the two screening arms were analyzed.

Main Results:

• A total of 84.2% (Arm A) and 89.6% (Arm B) of participants were screened.
• SCORE identified 45.1% as low risk, 26.5% as intermediate risk, and 28.4% as high risk.
• CAC scoring identified 76.0% as low risk, 15.1% as high risk, and 8.9% as very high risk.
• CAC scoring resulted in a significant reduction in individuals recommended for preventive treatment compared to SCORE (37.2% reduction in women, 28.8% in men).

Conclusions:

• CAC scoring classified significantly fewer individuals, both men and women, at increased CVD risk compared to SCORE.
• Consequently, less preventive treatment was indicated when using CAC scoring.
• These findings highlight potential differences in risk stratification and treatment allocation between the two screening methods.