Kvist T V, Lindholt J S, Rasmussen L M, Søgaard R, Lambrechtsen J, Steffensen F H, Frost L, Olsen M H, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen A C P
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark.
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
Eur J Vasc Endovasc Surg. 2017 Jan;53(1):123-131. doi: 10.1016/j.ejvs.2016.10.010. Epub 2016 Nov 24.
OBJECTIVE/BACKGROUND: This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD.
In total, 2060 randomly selected Danish men and women aged 65-74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden.
Attendance rates were 64.9% (n = 678) and 63.0% (n = 640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9-14.9) in men and 1.1% (95% CI 0.3-1.9) in women, respectively (p < .001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p < .001), along with a significant increase in median CAC score with age (p = .03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8-21.8) than in women (11.2%, 95% CI 8.7-13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%).
Owing to the higher prevalence of severe conditions, such as aneurysms and CAC ≥ 400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.
目的/背景:这项基于大规模人群的随机筛查试验的初步研究,调查了心血管疾病(CVD)多方面筛查的可行性、可接受性和相关性(临床和亚临床心血管疾病的患病率以及预防不足的比例)。
总共2060名年龄在65 - 74岁之间随机选取的丹麦男性和女性接受了以下检查:(i)低剂量非增强计算机断层扫描以检测冠状动脉钙化(CAC)和主动脉/髂动脉瘤;(ii)检测心房颤动(AF);(iii)测量肱动脉和踝部血压;以及(iv)检测胆固醇和糖化血红蛋白A1c的血液水平。采用基于网络的自助预约和数据管理来减轻行政负担。
男性和女性的出勤率分别为64.9%(n = 678)和63.0%(n = 640)。总共39.7%的人收到了医疗预防行动的建议。男性和女性的动脉瘤患病率分别为12.4%(95%置信区间[CI] 9.9 - 14.9)和1.1%(95% CI 0.3 - 1.9)(p <.001)。37.8%的男性和11.3%的女性CAC评分> 400(p <.001),并且CAC评分中位数随年龄显著增加(p =.03)。外周动脉疾病在男性中比女性更普遍(男性18.8%,95% CI 15.8 - 21.8)(女性11.2%,95% CI 8.7 - 13.6)。在新发现的房颤方面(男性1.3%,女性0.5%)、潜在高血压方面(男性9.7%,女性11.5%)、高胆固醇血症方面(男性0.9%,女性1.1%)或糖尿病方面(男性2.1%,女性1.3%),两性之间未发现显著差异。
由于动脉瘤和CAC≥400等严重疾病在男性中的患病率较高,对心血管疾病的筛查在男性中似乎比女性更为审慎。与其他筛查项目相比,出勤率是可以接受的,并且筛查项目的后勤结构证明是成功的。