Multi-modality non-invasive cardiovascular screening and sex-specific outcomes: the Viborg Screening Program.

Area of Science:

• Cardiology
• Public Health
• Preventive Medicine

Background:

• Cardiovascular screening trials have primarily focused on men, with limited data on its impact on all-cause mortality in both sexes.
• This study investigates the effectiveness of a multi-modality screening program in reducing mortality in a general population aged 67.

Purpose of the Study:

• To evaluate the effect of a comprehensive cardiovascular screening program on all-cause mortality in 67-year-old individuals.
• To determine if the screening program's benefits differ between sexes and individuals with or without prior cardiovascular disease.

Main Methods:

• A prospective, population-based study (Viborg Screening Program) in Denmark involving 67-year-olds invited for screening.
• Intervention included screening for carotid plaque, peripheral artery disease, abdominal aortic aneurysm, hypertension, cardiac arrhythmia/ischemia, and diabetes mellitus.
• Propensity score matching (1:3 ratio) and Cox proportional hazards models were used for analysis under the intention-to-invite principle, with post hoc sex-stratified analyses.

Main Results:

• The study included 5412 invitees and 16,236 controls after matching. During a median follow-up of 5.8 years, invitees had a 24% lower all-cause mortality rate (HR 0.76; P < .001).
• The number needed to invite to prevent one death was 49. Cardiovascular mortality HR was 0.76, major adverse cardiovascular events HR was 1.10, and major adverse limb events HR was 0.70.
• All-cause mortality HRs were 0.73 for men and 0.82 for women. The HR was 0.70 for those without prior CVD and 0.97 for those with prior CVD.

Conclusions:

• Multi-modality non-invasive cardiovascular screening effectively reduces 5-year all-cause mortality in 67-year-olds, irrespective of sex.
• The findings suggest that prioritizing individuals without known cardiovascular disease (CVD) could potentially amplify the population-level impact of screening programs.