BackgroundThe significant increase in the average life expectancy has increased the societal challenge of managing serious age-related diseases, especially cancer and cardiovascular diseases. A routine check by a general practitioner is not sufficient to detect incipient cardiovascular disease.DesignPopulation-based randomized clinically controlled screening trial.MethodsParticipants: 45,000 Danish men aged 65–74 years living on the Island of Funen, or in the surrounding communities of Vejle and Silkeborg. No exclusion criteria are used.Interventions: One-third will be invited to cardiovascular seven-faceted screening examinations at one of four locations. The screening will include: (1) low-dose non-contrast CT scan to detect coronary artery calcification and aortic/iliac aneurysms, (2) brachial and ankle blood pressure index to detect peripheral arterial disease and hypertension, (3) a telemetric assessment of the heart rhythm, and (4) a measurement of the cholesterol and plasma glucose levels. Up-to-date cardiovascular preventive treatment is recommended in case of positive findings.Objective: To investigate whether advanced cardiovascular screening will prevent death and cardiovascular events, and whether the possible health benefits are cost effective.Outcome: Registry-based follow-up on all cause death (primary outcome), and costs after 3, 5 and 10 years (secondary outcome).Randomization: Each of the 45,000 individuals is, by EPIDATA, given a random number from 1–100. Those numbered 67+ will be offered screening; the others will act as a control group.Blinding: Only those randomized to the screening will be invited to the examination;the remaining participants will not.Numbers randomized: A total of 45,000 men will be randomized 1:2.Recruitment: Enrollment started October 2014.Outcome: A 5 % reduction in overall mortality (HR = 0.95), with the risk for a type 1 error = 5 % and the risk for a type II error = 80 %, is expected. We expect a 2-year enrollment, a 10-year follow-up, and a median survival of 15 years among the controls. The attendance to screening is assumed to be 70 %.DiscussionThe primary aim of this so far stand-alone population-based, randomized trial will be to evaluate the health benefits and costeffectiveness of using non-contrast full truncus computer tomography (CT) scans (to measure coronary artery calcification (CAC) and identify aortic/iliac aneurysms) and measurements of the ankle brachial blood pressure index (ABI) as part of a multifocal screening and intervention program for CVD in men aged 65–74.Attendance rate and compliance to initiated preventive actions must be expected to become of major importance.Trial registrationCurrent Controlled Trials: ISRCTN12157806 (21 March 2015).

FIS is larger in late presenters (>12 h) than early presenters after primary angioplasty for STEMI. However, substantial myocardial salvage can be obtained beyond the 12 h limit, even when the infarct-related artery is totally occluded.

The benefit of transfer for primary angioplasty based on the composite endpoint was sustained after 3 years. For patients with characteristics as those in DANAMI-2, primary angioplasty should be the preferred treatment strategy when inter-hospital transfer can be completed within 2 h.

Background: 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.Methods: 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. Results: 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.Conclusion: 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. decrease in hospital admissions or health-related costs from CVDs 1,2 . In particular, coronary heart disease remains a leading cause of premature death 3 . Screening for traditional risk markers has proved unsuccessful in reducing mortality and morbidity 4 -6 . However, adding new, more specific imaging can improve risk discrimination

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