DANCAVAS: CV Screening Did Not Significantly Reduce Incidence of Death in Older Males

Findings from the DANCAVAS trial, presented Aug. 27 during ESC Congress 2022 in Barcelona, found comprehensive cardiovascular screening in older adult males did not significantly reduce the incidence of death from any cause over the course of more than five years.

The trial, the results of which were also simultaneously published in the New England Journal of Medicine, randomly assigned (1:2 ratio) 46,611 adult men between the ages of 65 to 74 and living in 15 Danish municipalities to undergo screening, including coronary-artery calcium scoring, ankle–brachial blood-pressure measurements and blood testing for diabetes mellitus and hypercholesterolemia, or no screening. The primary outcome was death from any cause and secondary outcomes were stroke, myocardial infarction, amputation due to vascular disease, aortic dissection and aortic rupture. The median follow-up was 5.6 years.

Overall, the trial did not meet the primary outcome. Of the 10,471 men who underwent screening, 2,106 (12.6%) died as compared with 3,915 (13.1%) in the non-screening group. Broken down by event, the hazard ratio for stroke in the screening group, as compared with the non-screening 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). No significant differences between the two groups in terms of safety outcomes were observed.

Despite not meeting the primary outcome, the study authors, including Axel Cosmus Pyndt Diederichsen, PhD, who presented the findings, said "the 95% confidence interval suggests that the plausible results range from no reduction in risk to a 10% reduction, so a clinically important benefit cannot be ruled out." They also note that results of the subgroup analyses "suggest the possibility of a greater benefit of screening among participants between 65 and 69 years of age."

According to the study authors, additional research is needed to address some of the limitations of DANCAVAS, including whether results among women, other age groups, non-white persons, or person living in countries with different health systems would be similar. They also caution that the "potential harms of screening must also be considered in the evaluation of a screening program," noting that a slightly higher incidence of bleeding events and post-operative death after open surgical repair occurred in the screening group.

Meanwhile, a cost-effectiveness evaluation based on five years of follow-up in the DANCAVAS trial published in the European Heart Journal suggests "that comprehensive cardiovascular disease screening is cost-effective and more than compares with the cancer screening programs that are already implemented in many European health care systems." The study authors conclude that screening "could be a pivotal prevention strategy in order to again accelerate the prevention of cardiovascular disease throughout Europe."

Clinical Topics: Cardiac Surgery, Dyslipidemia, Vascular Medicine, Aortic Surgery, Homozygous Familial Hypercholesterolemia

Keywords: ESC Congress, ESC22, ACC International, Aortic Rupture, Calcium, Hypercholesterolemia, Myocardial Infarction, Stroke, Aneurysm, Dissecting, Diabetes Mellitus, Amputation, Arteries

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