Dahl Marie, Frost Lars, Søgaard Rikke, Klausen Ib Christian, Lorentzen Vibeke, Lindholt Jes
Cardiovascular Research Centre, Regional Hospital Central Denmark, Heibergs Allé 4, 8800, Viborg, Denmark.
Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark.
BMC Cardiovasc Disord. 2018 Feb 5;18(1):20. doi: 10.1186/s12872-018-0758-8.
Reducing women's cardiovascular risk and the economic costs associated with cardiovascular diseases (CVD) and diabetes (DM) continues to be a challenge. Whether a multifaceted CVD screening programme is beneficial as a preventive strategy in women remains uncertain. The aim of this study was to investigate the prevalence of CVD and DM as well as the acceptability toward screening and preventive actions.
An observational study was performed among all women born in 1936, 1941, 1946 and 1951 living in Viborg Municipality, Denmark, from October 2011. In total, 1984 were invited to screening for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), hypertension (HT), atrial fibrillation (AF), DM and dyslipidaemia. Participants with positive tests were offered prophylactic intervention including follow-up consultations in case of AAA, PAD and/or CP. Participants with AAA ≥ 50 mm were referred to specialists in vascular surgery. Women with AF or potential familial hypercholesterolaemia (FH) were referred to cardiology work-up.
Among those invited, 1474 (74.3%) attended screening, but the attendees' share decreased with increasing age groups (p < 0.001). AAA was diagnosed in 10 (0.7%) women, PAD in 101 (6.9%) and CP in 602 (40.8%). The percentage of women with these conditions rose with increasing age group (p < 0.05). Unconfirmed potential HT was observed in 94 (6.4%), unknown AF in 6 (0.4%), DM in 14 (1%) and potential FH in 35 (2.4%). None of these findings differed across age groups. Among the 631 women diagnosed with AAA, PAD and/or CP, 182 (28.8%) were already in antiplatelet and 223 (35.3%) in lipid-lowering therapy prior to screening. Antiplatelet therapy was initiated in 215 (34.1%) and lipid-lowering therapy in 191 (30.3%) women. Initiation of antiplatelet and lipid-lowering therapy was further recommended to 134 (21.2%) and 141 (22.4%) women, respectively, who hesitated to follow the recommendation.
The study recorded an acceptable total attendance rate, even though a significantly lower attendance rate was observed in the eldest women. The identified hesitation towards prophylactic therapy may affect the rationale and effectiveness of CVD screening, and hesitation seems a critical issue that should be addressed in the design of future screening programmes.
降低女性心血管疾病风险以及与心血管疾病（CVD）和糖尿病（DM）相关的经济成本仍然是一项挑战。多方面的CVD筛查计划作为女性预防策略是否有益仍不确定。本研究的目的是调查CVD和DM的患病率以及对筛查和预防措施的接受度。
对2011年10月起居住在丹麦维堡市的所有出生于1936年、1941年、1946年和1951年的女性进行了一项观察性研究。总共邀请了1984名女性进行腹主动脉瘤（AAA）、外周动脉疾病（PAD）、颈动脉斑块（CP）、高血压（HT）、心房颤动（AF）、DM和血脂异常的筛查。检测结果呈阳性的参与者接受了预防性干预，包括AAA、PAD和/或CP患者的后续咨询。AAA≥50mm的女性被转诊至血管外科专家处。AF或潜在家族性高胆固醇血症（FH）的女性被转诊至心脏病学检查。
在受邀者中，1474人（74.3%）参加了筛查，但随着年龄组的增加，参加者的比例下降（p<0.001）。10名（0.7%）女性被诊断为AAA，101名（6.9%）为PAD，602名（40.8%）为CP。患有这些疾病的女性比例随着年龄组的增加而上升（p<0.05）。观察到94名（6.4%）女性存在未经证实的潜在HT，6名（0.4%）为不明AF，14名（1%）为DM，35名（2.4%）为潜在FH。这些发现没有一个在不同年龄组中有差异。在631名被诊断为AAA、PAD和/或CP的女性中，182名（28.8%）在筛查前已经在接受抗血小板治疗，223名（35.3%）在接受降脂治疗。215名（34.1%）女性开始接受抗血小板治疗，191名（30.3%）女性开始接受降脂治疗。对于犹豫是否遵循建议的134名（21.2%）和141名（22.4%）女性，分别进一步建议她们开始抗血小板和降脂治疗。
该研究记录的总参与率是可以接受的，尽管年龄最大的女性参与率明显较低。所发现的对预防性治疗的犹豫可能会影响CVD筛查的基本原理和有效性，犹豫似乎是一个在未来筛查计划设计中应解决的关键问题。
