Cardiovascular Screening Research Articles

Short-term impact of cardiovascular screening by traditional risk assessment or coronary artery calcium score on health-related quality of life: the ROBINSCA trial.

Evidence on the impact of screening for cardiovascular diseases (CVDs) on health-related quality of life (HRQoL) is important for policy decisions about screening implementation and to uncover teachable moments to motivate healthy lifestyle choices. It is unknown whether screening by cardiac computed tomography (CT) scan has a stronger impact on HRQoL than screening by traditional risk prediction models. The study aims to investigate differences in HRQoL across the screening process between participants who were randomized to CVD risk estimation by coronary artery calcium score or Systematic COronary Risk Evaluation. A subset of 2687 ROBINSCA participants filled in questionnaires at (T0) randomization, (T1) invitation, (T2) 1-3 days before screening, (T3) 1-3 days after, and (T4) screening result. Generic HRQoL (SF-12; EQ-5D) and anxiety (STAI-6) were measured. We investigated the differences in changes in HRQoL across the screening process with linear mixed models. We found comparable levels of HRQoL at all screening moments for the two intervention groups. Mental health scores were worse at invitation and randomization than at the later time points, irrespective of screening group (all P < 0.001). A result indicating a heightened CVD risk was associated with increased anxiety in the CT screening group. Computed tomography screening for CVD risk has no detrimental impact on HRQoL and anxiety levels compared to screening by traditional risk assessment. Receiving an invitation to screenning or a result implying increased CVD risk could function as teachable moments for high-risk individuals. ROBINSCA trial registration number: NTR6471 in Dutch Trial Register (NTR).

Will DANCAVAS be the most important screening trial in the last 50 years?

Screening trials for cardiovascular disease have not demonstrated a reduction in all-cause mortality. The Danish Cardiovascular Screening trial (DANCAVAS) involved men aged 65–74 years old who were randomized to an invitation to undergo screening or not. While the 5-year interim analysis did not show a statistically significant benefit in the primary outcome of all-cause mortality, HR 0.95 (CI 0.90–1.00), a sub-group analysis of men age 65–69 did show a lower hazard ratio of 0.89 (CI 0.83–0.96). Given the widening difference between screened and un-screened participants, as well as the benefit in younger subjects, it is likely that the next analysis will demonstrate a statistically-significant benefit of screening. In this commentary we argue why this trial will almost certainly become one of the most influential screening trials and why heeding its most important lesson, the use of coronary artery calcium scoring, has the potential to save countless lives.

Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis.

Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of electrocardiogram (ECG) abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls. Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000-2021. Patients were matched 1:3 to controls without AAV on age, sex, and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex, and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample. A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%), and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49-2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16-22%) vs 9.41% (8-11%). Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.

Cardiovascular risk factors among Roma and non-Roma populations in underprivileged settlements.

The 'Taking the screening tests close to the people' program offers cardiovascular screening to the inhabitants of underprivileged settlements. This study aimed to evaluate the cardiovascular risk factors of underprivileged populations, including individuals who described themselves as belonging to the Roma population. During the program, we collected information about demographic features, lifestyle and current illnesses. A general health assessment (body weight, height, blood pressure and fasting blood glucose) and cardiovascular examination were performed. We analysed data on both Roma and non-Roma groups and used Pearson's chi-squared test and multiple logistic regression models to analyse the factors that contribute to the onset of comorbidities, with a special focus on ethnicity. Data from 6211 participants were processed. Based on self-reports, the non-Roma population consisted of 5352 respondents (1364 men (25.5%) and 3988 women (74.5%)), and the Roma population comprised 859 respondents (200 men (23.3%) and 659 women (76.7%)). A total of 91.2% (4849) of the non-Roma population and 92.5% (788) of the Roma population exercised less than 3h per week (p < 0.001). Of the non-Roma population, 71.7% (3512) had a body mass index above 25kg/m2, while the corresponding figure was 72.4% (609) in the Roma population (p = 0.709). The median body mass index was 28.0 (24.6-31.9) in the non-Roma population and 28.8 (24.5-33.0) in the Roma population (p < 0.001). The prevalence of active smokers was 28.7% (1531) in the non-Roma population and 60.3% (516) in the Roma population (p < 0.001). The prevalence of hypertension was 54.9% (2824) in the non-Roma population and 49.8% (412) in the Roma population (p < 0.001). The prevalence of diabetes was 11.5% (95) in the Roma population and 12.2% (619) in the non-Roma population (p < 0.001). We found a high prevalence of overweight and obesity, a lack of physical activity and an remarkably high smoking rate in the studied underprivileged population. Both type 2 diabetes and hypertension were more common among people living in underprivileged settlements than in the general Hungarian population. People living in underprivileged settlements need more attention in primary care.

Association Between Kidney Stone History and Cardiovascular Event Risk in US Adults

ObjectivesTo determine the association between kidney stone history and predicted 10-year risk of atherosclerotic cardiovascular disease events in a nationally representative US adult sample without existing cardiovascular disease. MethodsThis was a cross-sectional study of the 2017-2020 National Health and Nutrition Examination Survey that included a nationally representative sample of 3,842 adults aged 40-79 free from cardiovascular disease. Kidney stone history was assessed through self-reporting. The 10-year risk of an atherosclerotic cardiovascular disease event was predicted using the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations. ResultsThe weighted prevalence of kidney stones was 12.2% (95% CI: 10.5% to 14.1%). In unadjusted analysis, the odds of borderline or higher (≥5%) atherosclerotic cardiovascular disease risk were higher in stone formers (odds ratio=1.56; 95% CI 1.01-2.40; P=0.046). This association persisted after adjustment for demographics and clinical covariates (adjusted odds ratio=1.57; 95% CI=1.02 to 2.43; P=0.04). A significant interaction by biological sex was identified (p=0.002), with excess risk conferred by kidney stones in men but not women. ConclusionsKidney stone history was independently associated with increased 10-year predicted atherosclerotic cardiovascular disease event risk, with excess risk observed among men but not women. Intensified cardiovascular disease screening may be warranted among stone formers given their increased cardiovascular risk.

Targeted Text Message Recall System to Increase Uptake of Cardiovascular Screening in Australian General Practice – Results of the Text to Detect Randomised Controlled Trial

Targeted Text Message Recall System to Increase Uptake of Cardiovascular Screening in Australian General Practice – Results of the Text to Detect Randomised Controlled Trial

A cross-sectional investigation of a mobile health clinic run by undergraduate pharmacy students providing services to underserved communities.

Mobile health clinics have been used to provide healthcare to underserved communities, especially during the COVID-19 pandemic. Student-led clinics, operated by undergraduate health students, offer valuable training while serving these populations. This cross-sectional study investigated the demographic characteristics and services provided by a mobile health clinic run by undergraduate pharmacy students, assessing its potential to reach underserved communities. The mobile health clinic operated from October 2023 to April 2024, staffed by 36 fourth-year pharmacy students. Services included cardiovascular disease risk screening and lifestyle advice. Demographic and service data were collected using an electronic primary care system and analysed with descriptive statistics. The clinic served 716 users, with a demographic breakdown of 53.2% female and 46.8% male, predominantly aged 31-60years. Users were ethnically diverse. Services provided included blood pressure (91.3%), BMI (91.3%), and diabetes risk assessments (54.9%). Many users reported low risk for smoking and alcohol consumption, but varied levels of physical activity. Referrals were made for cardiovascular disease risk and lifestyle support. The mobile health clinic effectively reached a diverse, underserved population, providing essential health services and facilitating student training. Further research is needed to evaluate the long-term impact and cost-effectiveness of such clinics, and the follow-up care for referred patients.

COPD is associated with increased cardiovascular disease risk independent of phenotype.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide that frequently presents with concomitant cardiovascular diseases. Despite the pathological distinction between individual COPD phenotypes such as emphysema and chronic bronchitis, there is a lack of knowledge about the impact of COPD phenotype on cardiovascular disease risk. Thus, this study aimed to utilize a nationally representative sample to investigate cardiovascular disease prevalence in patients with COPD with emphysema and chronic bronchitis phenotypes. Data from 31,560 adults including 2504 individuals with COPD, collected as part of the National Health and Nutrition Examination Survey (1999-2018), were examined. A significantly increased cardiovascular disease risk, including coronary heart disease, heart failure, myocardial infarction and stroke, was identified in patients with COPD among all disease phenotypes. Particularly, compared to those without COPD, individuals with chronic bronchitis presented with 1.76 (95% CI: 1.41-2.20) times greater odds, individuals with emphysema with 2.31 (95% CI: 1.80-2.96) times greater odds, while those with a concurrent phenotype (combined chronic bronchitis and emphysema) exhibited 2.98 (95% CI: 2.11-4.21) times greater odds of reporting cardiovascular diseases. Our data confirms that patients with COPD present an elevated risk of developing cardiovascular disease among all phenotypes, with the most marked increase being in those with concurrent chronic bronchitis and emphysema phenotypes. These findings emphasize the need for awareness and appropriate cardiovascular screening in COPD.

Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments.

Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.

Prevalence of interarm blood pressure difference is notably higher in women; the Viborg population-based screening program (VISP)

BackgroundBilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm.MethodsThis sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results).ResultsWe included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32–1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140–159/90–99 mmHg (OR 1.68, 95% CI 1.44–1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49–2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm.ConclusionFemale sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening.Trial registration for VISPNCT03395509:10/12/2018.

Effect of Dialysis Modality and Membrane Permeability on FGF 23 Level and Cardiovascular Calcification in ESRD Patients

Abstract Introduction Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD) and vascular calcification is one of the strongest predictors of cardiovascular risk. The prevalence of vascular calcification increases as glomerular filtration rate (GFR) declines and calcification occurs years earlier in CKD patients than in the general population. (26). Aim of the Study To study the effect of hemodialysis modality in controlling FGF-23and to determine the impact of FGF23 on cardiovascular calcification Patients and Methods We selected 50 patients ESRD maintained on hemodialysis divided into 2 groups, Group 1: comprised of 25 patients maintained on hemodialysis with high flux dialyzer and Group 2: comprised of 25 maintained on weekly session of hemodiafiltration and comparison between both groups regarding FGF23 serum level in addition to cardiovascular screening for calcifications using ECHO, Carotid intima-media thickness, and carotid duplex. Results we found that Post dialysis FGF23 was significantly lower in “hemodiafiltration patients” than ‘hemodialysis patients” and Reduction ratio was significantly higher in “hemodiafiltration patients”(P &amp;lt; 0.001).ECHO score and carotid duplex score were insignificantly different between both groups, but carotid intima-media thickness was significantly higher in haemodialysis patients (P value 0.035). Post HDF FGF 23 had a significant positive correlation with IMT (r = 0.579, P = 0.008). Serum FGF23 post-HD and HDF had significant positive correlation with serum Calcium (r = 0.659, P = 0.002), (r = 0.474, P = 0.035), PTH (r = 0.485, P = 0.03), (r = 547, P = 0.013) and CRP (r = 0.646, P = 0.002), (r = 707, P &amp;lt; 0.001) and serum Phosphorus (r = 0.462, P = 0.04), (r = 478, P = 0.033) respectively. In HD group Carotid Duplex Score had significant positive correlation with serum Ca (r = 0.469, P = 0.037), while in HDF group Carotid Duplex Score had significant positive correlation with PTH (r = 0.59, P = 0.006). Conclusion Using online HDF technique showed a significant reduction of FGF23 and improvement of carotid intima-media thickness calcification score.

Temperature-responsive hydrogel-grafted vessel-on-a-chip: Exploring cold-induced endothelial injury.

Cold-induced vasoconstriction is a significant contributor that leads to chilblains and hypothermia in humans. However, current animal models have limitations in replicating cold-induced acral injury due to their low sensitivity to cold. Moreover, existing in vitro vascular chips composed of endothelial cells and perfusion systems lack temperature responsiveness, failing to simulate the vasoconstriction observed under cold stress. This study presents a novel approach where a microfluidic bioreactor of vessel-on-a-chip was developed by grafting the inner microchannel surface of polydimethylsiloxane with a thermosensitive hydrogel skin composed of N-isopropyl acrylamide and gelatin methacrylamide. With a lower critical solution temperatureset at 30°C, the gel layer exhibited swelling at low temperatures, reducing the flow rate inside the channel by 10% when the temperature dropped from 37°C to 4°C. This well mimicked the blood stasis observed in capillary vessels in vivo. The vessel-on-a-chip was further constructed by culturing endothelial cells on the surface of the thermosensitive hydrogel layer, and a perfused medium was introduced to the cells to provide a physiological shear stress. Notably, cold stimulation of the vessel-on-a-chip led to cell necrosis, mitochondrial membrane potential (ΔΨm) collapse, cytoskeleton disaggregation, and increased levels of reactive oxygen species. In contrast, the static culture of endothelial cells showed limited response to cold exposure. By faithfully replicating cold-induced endothelial injury, this groundbreaking thermosensitive vessel-on-a-chip technology offers promising advancements in the study of cold-induced cardiovascular diseases, including pathogenesis and therapeutic drug screening.

American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms

To evaluate the utilization of the American Academy of Pediatrics’ (AP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

Prospective cardiovascular events in patients with advanced thoracic cancer treated with immune checkpoint inhibitor

IntroductionMyocarditis is the most lethal cardiovascular immune related adverse events with a low incidence, depending on the studies. We prospectively studied the potential interest of a systematic screening to early detect immune related myocarditis and confirm the incidence of immune-induced myocarditis in advanced lung cancer and the impact of troponin systematic screening in early detection of other major cardiovascular events (MACE). Material and methodsThis prospective bicentric study includes adults who received at least one dose of immune checkpoint inhibitor (ICI) for advanced lung cancer. Cardiac biomarkers dosage, ECG and transthoracic echography (TTE) were done at baseline. Diagnosis of myocarditis was based on European Society of Cardiology recommendations. MACEs were reported during the observation period. ResultsAmong 298 patients, 5 (1.68 %) immune-induced myocarditis occurred, all being asymptomatic with at first troponin elevation, treated by corticosteroids and ICI’s discontinuation. No attributable death occurred, and no specific clinical characteristics were identified with myocarditis onset. Three patients were rechallenged with ICI after troponin normalization in the absence of other therapeutic options. Recurrence occurred in 2 patients, with a re-increase of troponin and a de novo modification of the ECG. Systematic cardiovascular screening also led to 14 cardiovascular diseases detection and 11 MACEs during ICI. ConclusionSystematic cardiovascular screening has uncovered slightly more immuno-induced myocarditis cases than reported previously, but without altering treatment strategies due to their subclinical nature. Additionally, it helps detecting other cardiovascular diseases in this comorbid population.

The barbershop paradigm: Community engagement for cardiovascular prevention

Barbershops and beauty salons provide community-specific opportunities to engage in cardiovascular disease screening and prevention. This editorial articulates the advantages of what is termed the “barbershop paradigm,” the community-engaged endeavor that leverages familiarity, trust, and stakeholder engagement to advance cardiovascular health. The authors summarize the neighborhood-based factors that contribute to cardiovascular health, and then identify the strategies implemented by ShopTalk and their specific advantages.

Cardiovascular Risk in Cancer Patients Treated with Immune Checkpoint Inhibitors: Challenges and Future Directions.

Cardiovascular disease is the leading cause of non-cancer related mortality and morbidity among people living with or cured from cancer. Immune checkpoint inhibitors (ICIs) are systemic anti-cancer therapies that have revolutionised the treatment of numerous cancers, even achieving durable long-term responses among patients with metastatic disease. However, the pro-inflammatory effects of ICIs have been postulated to increase the risk of atherosclerotic cardiovascular disease (ASCVD) in cancer survivorship. Standard modifiable cardiovascular risk factors can further contribute to ASCVD risk during cancer survivorship but are not routinely screened and are often untreated in patients with cancer. With the expanding use of ICIs leading to improved cancer survivorship, cardiovascular risk identification and prevention will be paramount in the care of patients with cancer. This review highlights the practical challenges associated with ASCVD prevention among the growing number of patients treated with ICIs for cancer, including balancing competing mortality risks from cancer and ASCVD, the lack of ICI-specific cardiovascular risk stratification tools, potential interactions between cardiovascular and oncological therapies, and barriers to implementation of cardiovascular screening and prevention within existing healthcare systems.

Smartphone-based digital point-of-care panel assay with enzymatic catalytic reaction

The recent pandemic improved awareness amongst the public of the need for rapid blood tests for community and home settings. In this work, we evaluated the performance of a digital, lipid panel test in microfluidic assay format which can be read using a smartphone camera. The PocDoc Lipid test is embedded within a cardiovascular screening application that utilizes the QRISK3 risk prediction algorithm to determine an individual's risk of having a cardiovascular event in the next 10 years and their healthy heart age. The test can be used to screen for individuals at risk of hyperlipidemia (e.g. high total cholesterol or triglycerides) and for individuals at high risk of cardiovascular disease at home or in community or surgery settings. The device was evaluated in a performance evaluation study, using 125 whole blood samples, following CLSI guidelines. Performance evaluation of the PocDoc device demonstrated accuracy that meets international NCEP guidelines and that is on par with other point-of-care tests. Sensitivity and specificity analysis supports the use of PocDoc to identify patients with hyperlipidemia or at high risk of cardiovascular disease. Bland-Altman analysis suggests that this point-of-care device can be used as an alternative to venous blood collection. This single-step model for cardiovascular disease risk measurement which can be done at home or in community settings may improve cardiovascular disease prevention.

Pre participation cardiovascular screening in runners: Survey of athletes of the grand raid 2023 in reunion island

Pre participation cardiovascular screening in runners: Survey of athletes of the grand raid 2023 in reunion island

Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study

ObjectivesTo evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players.MethodsThe ‘B-Pro Foot ECG’ is a multicentre observational study conducted in 82...

Evaluating the effectiveness of the cardiovascular assessment screening program with nurse practitioners and patients: results of a cluster randomised controlled trial

BackgroundThere is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada.MethodsA two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40–74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG).ResultsEight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category.ConclusionNP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting.Trial registrationClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.