Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium scoring: the ROBINSCA trial

Aalst, Carlijn M. van der; Denissen, Sabine J A M; Vonder, Marleen; Gratama, Jan W.; Adriaansen, H. J.; Kuijpers, Dirkjan; Vliegenthart, Rozemarijn; Lennep, Jeanine E. Roeters van; Harst, Pim van der; Braam, Richard L.; Dijkman, Paul R. M. van; Bruggen, Rykel van; Oudkerk, Matthijs; Koning, Harry J. de

doi:10.1093/ehjci/jeaa168

Cited by 62 publications

(33 citation statements)

References 23 publications

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“…In this BC cohort, prevalence of CV risk factors was significant, and higher as compared to the European general population (18,19). Most importantly, CV risk factors control was suboptimal, in particular in the case of dyslipidaemia and arterial hypertension.…”

Section: Usefulness Of a Baseline Cardio-oncologic Evaluation For Cardiovascular Preventionmentioning

confidence: 67%

Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer

Tini

Ameri

Buzzatti

et al. 2021

Front. Cardiovasc. Med.

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Background: Women with breast cancer (BC) represent a special population particularly exposed to cardiovascular disease (CVD) risk. However, cardiologic assessment in BC is mostly limited to detection of left ventricular dysfunction cardiotoxicity (LVD-CTX) due to anticancer treatments. Our aim was to comprehensively investigate CV profile and events in a contemporary BC cohort.Methods and Results: Records of BC patients referred for a Cardio-Oncologic evaluation before starting anticancer treatments, between 2016 and 2019, were retrospectively reviewed (n = 508). Information regarding prevalence and control of CV risk factors, and novel CVD diagnoses were extracted. Occurrence of LVD-CTX, CV events other than LVD-CTX and mortality was assessed. Mean age of study population was 64 ± 13 years; 287 patients were scheduled to receive anthracycline and 165 anti-HER2 therapy. Overall, 53% of BC women had ≥2 CV risk factors, and 67% had at least one of arterial hypertension, dyslipidaemia or diabetes mellitus not adequately controlled. Eighteen (4%) patients were diagnosed a previously unknown CVD. Over a mean follow-up of 2.5 ± 1 years, 3% of BC patients developed LVD-CTX, 2% suffered from other CV events and 11% died. CV risk factors were not associated with LVD-CTX, except for family history of CAD. On the contrary, patients with other CV events exhibited a worse CV profile. Those who died more commonly experienced CV events other than LVD-CTX (p = 0.02).Conclusions: BC women show a suboptimal CV risk profile and are at risk of CV events not limited to LVD-CTX. A baseline Cardio-Oncologic evaluation was instrumental to implement CV prevention and to optimize CV therapies.

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Section: Usefulness Of a Baseline Cardio-oncologic Evaluation For Cardiovascular Preventionmentioning

confidence: 67%

Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer

Tini

Ameri

Buzzatti

et al. 2021

Front. Cardiovasc. Med.

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“…Another prevailing barrier is the lack of experimental evidence to show improved hard clinical outcomes of CAC based ASCVD risk management 115. The ongoing ROBINSCA (Risk Or Benefit In Screening for Cardiovascular Disease) trial aims at generating such evidence by comparing a risk factor based approach with a CAC based strategy 116. The inclusion criteria used, which enriched the study population with individuals with specific risk factors such as obesity, tobacco use, or a family history of premature CVD, limits generalizability to the broad general population; however, the study can shed light on the potential value of CAC in intermediate and high risk groups.…”

Section: Overcoming Barriers To Adoptionmentioning

confidence: 99%

Role of coronary artery calcium score in the primary prevention of cardiovascular disease

Nasir

Cainzos‐Achirica

2021

BMJ

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First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called “power of zero”), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.

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“…Data from the large-scale RCTs, indicating that CAC screening for CHD will reduce CHD-related mortality and morbidity, are still lacking, but the outcomes of the only large-scale population-based randomized-controlled screening trial for cardiovascular diseases (ROBINSCA: Risk Or Benefit in Screening for CArdiovascular disease are being expected soon. Recent results showed that the early detection of a high risk for developing coronary heart disease by CT screening (CAC score) might reduce preventive treatment substantially (75,76). This would imply that a significant reduction in potential overtreatment could be reduced by using the CAC score.…”

Section: Co-morbidity Reducing Strategiesmentioning

confidence: 99%

Implementation of lung cancer screening: what are the main issues?

Aalst

Haaf

Koning

2021

Transl Lung Cancer Res

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Two large-scale RCTs have shown computed tomography (CT) lung cancer screening to be efficacious in reducing lung cancer mortality (8-24% in men, 26-59% in women). However, lung cancer screening implicitly means personalised and risk-based approaches. Health care systems' implementation of personalised screening and prevention is still sparse, and likely to be of variable quality, because of important remaining uncertainties, which have been incompletely addressed or not at all so far. Further optimisation of lung cancer screening programs is expected to reduce harms and maintain or enhance benefit for eligible European citizens, whilst significantly reducing health care costs. Some main uncertainties (e.g., Riskbased eligibility, Risk-based screening intervals, Volume CT screening, Smoking Cessation, Gender and Sex differences, Cost-Effectiveness) are discussed in this review. 4-IN-THE-LUNG-RUN (acronym for: Towards INdividually tailored INvitations, screening INtervals and INtegrated co-morbidity reducingstrategies in lung cancer screening) is the first multi-centred implementation trial on volume CT lung cancer screening amongst 24,000 males and females, at high risk for developing lung cancer, across five European countries, started in January 2020. Through providing answers to the remaining questions with this trial, many EU citizens will swiftly benefit from this high-quality screening technology, others will face less harms than previously anticipated, and health care costs will be substantially reduced. Implementing a new cancer screening programme is a major task, with many stakeholders and many possible facilitators but also barriers and obstacle.

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Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium scoring: the ROBINSCA trial

Cited by 62 publications

References 23 publications

Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer

Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer

Role of coronary artery calcium score in the primary prevention of cardiovascular disease

Implementation of lung cancer screening: what are the main issues?

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