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Health program for prEvention of cardiovascuLar disEases based on a risk screeNing strategy with Ankle-brachial
Gina Domínguez-Armengol1,2, Francesc Ribas-Aulinas1,2, Elisabet Balló3
1Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain.
Insights
Integrating ankle-brachial index (ABI) screening into coronary heart disease (CHD) prevention identifies more high-risk individuals. This improves cardiovascular risk classification and reduces CHD incidence and mortality in adults aged 50-74.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Current coronary heart disease (CHD) risk functions often miss individuals who will experience cardiovascular (CV) events.
- Asymptomatic peripheral artery disease (PAD) is an underdiagnosed condition that increases CV risk.
- Improved CV risk classification is needed for effective primary prevention strategies.
Purpose of the Study:
- To evaluate the effectiveness of integrating an ankle-brachial index (ABI) screening program into existing CHD risk detection.
- To identify high-risk populations with asymptomatic PAD.
- To reduce the incidence of CHD and mortality in individuals aged 50-74 years.
Main Methods:
- A pragmatic randomized cluster trial involving 274 primary care centers.
- Two groups: current CHD risk strategy vs. current strategy plus ABI screening for PAD.
- Patients aged 50-74 with CHD risk ≥ 7% and PAD risk ≥ 7% were assessed using ABI.
- ABI ≤ 0.9 led to CHD risk reclassification and guideline-based recommendations.
Main Results:
- The study aims to demonstrate direct health improvements, including reduced CHD incidence and better control of CV risk factors.
- Expected outcomes include a decrease in major adverse cardiovascular events (MACE) and all-cause mortality.
- The project addresses the need to recover and enhance cardiovascular risk prevention efforts post-COVID-19.
Conclusions:
- Integrating ABI screening can significantly enhance the identification of individuals at high risk for cardiovascular events.
- This strategy has the potential to improve cardiovascular risk management and reduce associated mortality.
- The findings will support the recovery and strengthening of preventive cardiology services.
Introduction:
The use of risk functions to individualize preventive interventions is a key strategy in the primary prevention of coronary heart diseases (CHD). Unfortunately, most risk functions still fail to identify many individuals who will experience a cardiovascular (CV) event. Detecting individuals with asymptomatic peripheral artery disease (PAD) with a new risk function could improve CV risk classification. The aim is to evaluate the effectiveness of integrating an ankle-brachial index (ABI) program into the current CHD risk detection strategy to identify populations at high risk of asymptomatic PAD, reducing the incidence of CHD and mortality in those aged 50 to 74 years.
Methods:
This study is a pragmatic randomized cluster trial. A total of 274 primary care centers will be randomized into two groups that will either maintain the current CHD risk detection strategy or add a screening program to detect asymptomatic PAD using ABI. In routine clinical practice, 10-year CHD and PAD risk are assessed using the Framingham-adapted (REGICOR) function and the REASON function, respectively. The study population will consist of patients aged 50 to 74 years with a CHD risk ≥ 7% and PAD risk ≥ 7%, making them candidates for an ABI measurement. Cases with an ABI result ≤ 0.9 will have their CHD reclassified as high or very high by doubling the initial REGICOR score and receive the recommendations of the lipid and cardiovascular risk guideline. The primary outcomes will be hard CHD, major adverse cardiovascular events (MACE), all-cause mortality, and improvement in CVD risk factors. Secondary outcomes include CHD (a composite of angina and hard CHD), cerebrovascular disease, and adverse effects from lipid-lowering medication. Survival analysis will estimate the effectiveness of adding the ABI screening strategy, with Cox models (intention-to-treat) and marginal structural models controlling for confounding variables.
Results And Discussion:
Direct health improvements in the intervened population are expected, including a reduction in CHD incidence and its risk factors. This project is particularly valuable, as delays in screenings and control of CV risk factors have accumulated after the COVID-19 pandemic. Therefore, this work is expected to help recover and enhance cardiovascular risk prevention efforts.
Clinical Trial Registration:
ClinicalTrials.gov, NCT05884840.
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Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...