External validity of a cardiovascular screening including a coronary artery calcium examination in middle-aged individuals from the general population

Abstract

Background Coronary artery calcium is important in cardiovascular risk stratification, but this knowledge is based on studies with a significant selection bias. This study aims to evaluate the external validity of a screening programme including coronary artery calcium examination, and the association between coronary artery calcium and cardiovascular events. Design Multi-centre population based study. Methods Randomly selected middle-aged men and women ( N = 1751) free of cardiovascular disease were invited to the examination during 2009–2010. Participation rate in the examination was 70%. Participants ( n = 1227) and non-participants ( n = 524) were compared regarding: cardiovascular medical treatment, Charlson comorbidity index and socioeconomic status (evaluated by cohabitation, gross income and education). Study endpoints were cardiovascular events and mortality. Results Non-participants had a significant higher comorbidity ( p = 0.003) and a lower socioeconomic status ( p < 0.0001), while cardiovascular medical treatment was alike. Over a median follow-up time of 6.5 years the cardiovascular event and mortality rates were equal (6.7% vs. 6.4%, p = 0.80 and 0.4% vs. 0.5%, p = 0.76, respectively). Adjusted hazard ratio was 0.90 (95% confidence interval (CI) 0.63–1.37). Among participants, the extent of coronary artery calcium was significantly associated with increased risk of cardiovascular events (hazard ratio 1.92, 95% CI 1.03–3.54, hazard ratio 3.66, 95% CI 1.82–7.32, hazard ratio 6.51, 95% CI 3.17–13.36 for coronary artery calcium scores 1–99, 100–399, ≥400 AU, respectively). Conclusions Non-participants had a higher comorbidity index and a lower socioeconomic status, but the cardiovascular event and mortality rates were equal to those of participants. Thus, a screening programme including a coronary artery calcium examination had a high external validity regarding cardiovascular risk, but also a significant social imbalance.

Coronary artery disease risk reclassification by a new acoustic-based score

“…A total of 249 patients had a heart sound recording. In the DanRisk 5-year follow-up study (BIO-CAC; NCT02913144), a heart sound recording was obtained in 661 asymptomatic subjects undergoing coronary artery calcium scoring (CACS) [22, 23]. Subjects with a CACS above 400 were offered myocardial scintigraphy and subjects with a CAD-score (algorithm version 2) above 37 (n = 60) were offered CTA.…”

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

“…This is a relevant study bias, because the most severe HF patients as well as patients unwilling to actively participate in a study were excluded. The latter patients are likely those less adherent to therapy and to follow-up criteria [27].…”

Impact of a cardiovascular disease risk screening result on preventive behaviour in asymptomatic participants of the ROBINSCA trial

“…[8][9][10] In addition, recent evidence suggests a high external validity of CAC screening in a population-based prospective cohort in terms of cardiovascular risk. 11 The availability of risk stratification tools and effective preventive measures, such as modifying lifestyle behaviour and preventive medication, suggests that population-based screening might be a promising strategy in secondary prevention. 3,12 The Dutch Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA) trial is the first large population-based randomised controlled screening trial designed to investigate whether screening for a high CVD risk by means of either traditional risk assessment (arm A) or quantifying CAC using computed tomography (CT) scanning (arm B) followed by preventive treatment can reduce CHD-related morbidity and mortality in asymptomatic high-risk individuals compared to a control group.…”