Cardiovascular Screening Examination Research Articles

User-defined outcomes of the Danish cardiovascular screening (DANCAVAS) trial: A post hoc analyses of a population-based, randomised controlled trial.

The Danish cardiovascular screening (DANCAVAS) trial, a nationwide trial designed to investigate the impact of cardiovascular screening in men, did not decrease all-cause mortality, an outcome decided by the investigators. However, the target group may have varied preferences. In this study, we aimed to evaluate whether men aged 65 to 74 years requested a CT-based cardiovascular screening examination and to assess its impact on outcomes determined by their preferences. This is a post hoc study of the randomised DANCAVAS trial. All men 65 to 74 years of age residing in specific areas of Denmark were randomised (1:2) to invitation-to-screening (16,736 men, of which 10,471 underwent screening) or usual-care (29,790 men). The examination included among others a non-contrast CT scan (to assess the coronary artery calcium score and aortic aneurysms). Positive findings prompted preventive treatment with atorvastatin, aspirin, and surveillance/surgical evaluation. The usual-care group remained unaware of the trial and the assignments. The user-defined outcome was based on patient preferences and determined through a survey sent in January 2023 to a random sample of 9,095 men from the target group, with a 68.0% response rate (6,182 respondents). Safety outcomes included severe bleeding and mortality within 30 days after cardiovascular surgery. Analyses were performed on an intention-to-screen basis. Prevention of stroke and myocardial infarction was the primary motivation for participating in the screening examination. After a median follow-up of 6.4 years, 1,800 of 16,736 men (10.8%) in the invited-to-screening group and 3,420 of 29,790 (11.5%) in the usual-care group experienced an event (hazard ratio (HR), 0.93 (95% confidence interval (CI), 0.88 to 0.98; p = 0.010); number needed to invite at 6 years, 148 (95% CI, 80 to 986)). A total of 324 men (1.9%) in the invited-to-screening group and 491 (1.7%) in the usual-care group had an intracranial bleeding (HR, 1.17; 95% CI, 1.02 to 1.35; p = 0.029). Additionally, 994 (5.9%) in the invited-to-screening group and 1,722 (5.8%) in the usual-care group experienced severe gastrointestinal bleeding (HR, 1.02; 95% CI, 0.95 to 1.11; p = 0.583). No differences were found in mortality after cardiovascular surgery. The primary limitation of the study is that exclusive enrolment of men aged 65 to 74 renders the findings non-generalisable to women or men of other age groups. In this comprehensive population-based cardiovascular screening and intervention program, we observed a reduction in the user-defined outcome, stroke and myocardial infarction, but entail a small increased risk of intracranial bleeding. ISRCTN Registry number, ISRCTN12157806 https://www.isrctn.com/ISRCTN12157806.

Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes.

PurposeCardiovascular mortality remains high among patients with diabetes compared with the general population. The primary aim was to evaluate the interest in and demand for advanced cardiovascular screening in patients with diabetes; the secondary aim was to explore its efficiency in detecting unprotected subclinical cardiovascular disease (CVD).Patients and MethodsIn a cross-sectional design, randomly selected 40–60-year-old men and women with diabetes were invited to the screening trial. Screening encompassed (1) a comprehensive medical interview; (2) non-contrast computed tomography scanning to quantify coronary artery and aortic valve calcification, to measure left atrial size, to assess heart rhythm and to detect aortic and iliac dilatations; (3) ankle and brachial blood pressure measurements; and (4) blood and urine samples for measurements of HbA1c, lipid profile, renal function, NT-pro B-type natriuretic peptide (pro-BNP) and albuminuria. Primary outcome was participation rate; secondary outcome was rate of unprotected subclinical CVD.ResultsOf 465 invited patients, 191 (41.1%) attended screening. The participation rate was 40% (95% CI:33–47) for males and 42% (95% CI:36–48) for females. Twenty-four patients were excluded due to previous CVD. The remaining patients’ mean age was 52 years; 58% were males. Subclinical CVD was found in 64%, with a male preponderance (males 75% (95% CI:66–83; females 49% (95% CI:37–60)). Presence of severe coronary artery calcification (score ≥ 400) showed a male preponderance (males 19% (95% CI:12–27); females 7% (95% CI:3–16)). Aortic valve calcification, enlarged left atrial volume, atrial fibrillation, aortic dilatations, peripheral artery disease or increased pro-BNP were uncommon, and without any sex differences. Unprotected subclinical CVD was very common, and medical treatment was intensified in 60% (95% CI:53–68) of patients.ConclusionWe propose a feasible cardiovascular screening examination from which middle-aged patients with diabetes may benefit. However, the participation rate may be too low to warrant screening.

Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65-74 years.

The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease. Danish men aged 65-74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests. In all, 16 768 of 47 322 men aged 65-74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent). In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication. Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65-74 years. Uptake is lower than in aortic aneurysm screening.

Blood pressure and cholesterol level checks as dynamic interrelated screening examinations

This study analysed the determinants of screening uptake for blood pressure and cholesterol level checks. Furthermore, it investigated the presence of possible spillover effects from one type of cardiovascular screening to another type of cardiovascular screening. A dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) was adopted for the estimation. The outcome variables were the participation in blood pressure and cholesterol level checks by individuals in a given year. The balanced panel sample of 21,138 observations was constructed from 1,626 individuals from the British Household Panel Survey (BHPS) between 1996 and 2008. The analysis showed the significance of past screening behaviour for both cardiovascular screening examinations. For both cardiovascular screening examinations state dependence exist. The study also shows a significant spillover effect of the cholesterol level check on the blood pressure check and vice versa. Also a poorer health status led to a higher uptake for both types of screening examinations. Changes in recommendations have to consider the fact that taking part in one type of cardiovascular screening examination can influence the decision to take part in the other type of cardiovascular screening examination.

The Role of Screening for Sudden Cardiac Death in Young Competitive Athletes: A Critical Review

The purpose of this review is to examine the evidence surrounding the recommendations for cardiovascular screening in young competitive athletes. Sudden cardiac death (SCD) is the leading medical cause of death in athletes. There is widespread agreement that the primary purpose of the pre-participation cardiovascular screening examination is to identify athletes with conditions that predispose them to SCD. This can help inform the athlete of risks associated with exercise, define which athletes should pursue medical management for their condition, determine eligibility for competition, and delineate first-degree relatives who may need additional cardiac testing. Current cardiovascular screening with a traditional history and physical examination does not detect the majority of athletes at risk and provides false reassurance for those with silent underlying cardiovascular conditions. The addition of an electrocardiogram (ECG) enhances disease detection capabilities and modern athlete-specific ECG interpretation standards provide low false positive rates and improved cost efficiency. Future efforts should focus on physician education of ECG interpretation criteria, the development of an infrastructure to optimize cardiovascular screening, and providing evidence-based management strategies for athletes diagnosed with cardiac disorders. The goal of pre-participation screening is to identify athletes at risk for SCD. Advanced cardiovascular screening protocols have the potential to improve the health and safety of sport and should be considered in young competitive athletes, especially those deemed high risk.

ASSOCIATION BETWEEN CORONARY HEART DISEASE PREVALENCE AND ATTITUDES TOWARDS HEALTH AND PREVENTION IN THE MALE POPULATION OF TUMEN CITY

Aim. To assess the associations between the prevalence of coronary heart disease (CHD) and the attitudes towards one’s own health and prevention among 25–64-year-old male residents of Tumen City. Material and methods. The representative study sample was selected from the electoral lists of 25–64-year-old men — residents of one Tumen City district. As a part of a cardiovascular screening examination, the prevalence of CHD and the attitudes towards one’s own health and prevention were assessed, using the standard WHO MONICA-psychosocial questionnaire. Results. In male residents of Tumen City, aged 25–64 years, possible CHD and CHD by extended epidemiological criteria were associated with higher odds of perceived effectiveness of preventive measures, as well as with lower odds of severe disease development in previously healthy people. Men with definite CHD, compared to their healthy peers, were more sceptical about the potential of modern medicine in terms of cardiovascular disease (CVD) treatment and less sceptical about its potential in the area of CVD prevention. Conclusion. In the open population of Tumen City men aged 25–64 years, the presence of CHD was linked to a negative self-evaluation of health and more prevalent health complains. However, only men with definite CHD demonstrated a more responsible attitude towards their own health.

Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death.

Sudden cardiac death of a high school athlete is an alarming tragedy. Three preparticipation screening methods have been recommended to reduce its occurrence: specific cardiovascular history and physical examination, 12-lead ECG, and two-dimensional (2D) echocardiography. This study analyzes the cost effectiveness of each of these methods. The cost to perform each test and to evaluate abnormal screening findings were approximated. The years of life gained through detection of athletes with potential causes of sudden cardiac death were estimated. Overall, the approximate costs per year of life saved for the preparticipation cardiovascular screening examinations are: specific cardiovascular history and physical examination, $84,000; 12-lead ECG, $44,000; and 2D echocardiography, $200,000. The 12-lead ECG is the most cost effective preparticipation cardiovascular modality of the three currently recommended methods. Similar cost effectiveness for history and physical examination or 2D echocardiography would require respectively a 2-fold increase in sensitivity or 4.5-fold decrease in cost.

Heart volume and cardiovascular mortality. A 16 year follow-up study of 1984 healthy middle-aged men.

The possible association between heart size measured during a cardiovascular screening examination and cardiovascular mortality was studied in 1984 healthy men aged 40-59 years. At the 16-year follow-up 278 had died, 150 from cardiovascular diseases. Cardiovascular mortality was 2.2 times higher among the 122 men with heart size > or = 500 ml.m-2 than among those with heart size < 500 ml.m-2. This association was, however, exclusively confined to men with physical fitness below median in whom the corresponding mortality ratio was 4.6 (95% confidence interval 2.5-8.4; P < 0.001) after adjustment for age, smoking, cholesterol, blood pressure and heart rate. Heart size measurements from routine chest X-rays is fast, easy, inexpensive and appears to provide valuable, independent screening information in healthy, middle-aged men.

The Preparticipation Sports Examination: Cardiovascular Considerations for Screening

Physicians performing cardiovascular screening examinations in young and adult athletes should be aware of the rarity of exercise complications and the difficulty in separating cardiac adaptations to training from pathologic conditions. Coronary artery disease is the predominant cause of cardiac events during exercise in adults, whereas congenital abnormalities are the primary cause of exercise deaths in children. The preparticipation cardiac examination should include blood pressure measurements, visual inspection for the Marfan habitus, and auscultation designed to detect ventricular outflow obstruction. Other cardiovascular testing should be used when symptoms or findings warrant further evaluation.

A new method for long-term monitoring of the ballistocardiogram, heart rate, and respiration.

The principle of the static charge-sensitive-bed (SCSB) method is described. The method is simple and inexpensive. From the SCSB recording the ballistocardiogram (BCG) and respiratory movement can be simultaneously recorded by selective filtering of the original signal. The SCSB recording thus enables continuous long-term monitoring of the BCG, heart rate, respiratory rate, respiratory amplitude, and body movements. There are no electrodes or cables connected to the subject. The SCSB-BCG signal was studied by comparing the SCSB method with the conventional ultralow-frequency (ULF) acceleration BCG. The wave forms at rest and the amplitude responses to physical exercise were studied by both methods. Multiple recordings of the BCG, heart rate, respiratory movement, respiratory rate, and body movements after exercise and during sleep using the SCSB method are presented. The SCSB method opens new approaches to long-term studies of the regulation of myocardial performance, heart rate, and respiration. Applications of the SCSB method for clinical sleep studies, patient monitoring and cardiovascular screening examinations are discussed.