Department of Public Health, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Centre for Medical Imaging North-East Netherlands (CMI-NEN), University Medical Centre Groningen, Hanzeplein 1, EB45, Groningen 9713 GZ, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2020 Oct 20;21(11):1216-1224. doi: 10.1093/ehjci/jeaa168.
Screening for a high cardiovascular disease (CVD) risk followed by preventive treatment can potentially reduce coronary heart disease-related morbidity and mortality. ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) is a population-based randomized controlled screening trial that investigates the effectiveness of CVD screening in asymptomatic participants using the Systematic COronary Risk Evaluation (SCORE) model or coronary artery calcium (CAC) scoring. This study describes the distributions in risk and treatment in the ROBINSCA trial.
Individuals at expected elevated CVD risk were randomized into screening arm A (n = 14 478; SCORE, 10-year fatal and non-fatal risk); or screening arm B (n = 14 450; CAC scoring). Preventive treatment was largely advised according to current Dutch guidelines. Risk and treatment differences between the screening arms were analysed. A total of 12 185 participants (84.2%) in arm A and 12 950 (89.6%) in arm B were screened. In total, 48.7% were women, and median age was 62 (interquartile range 10) years. SCORE screening identified 45.1% at low risk (SCORE < 10%), 26.5% at intermediate risk (SCORE 10-20%), and 28.4% at high risk (SCORE ≥ 20%). According to CAC screening, 76.0% were at low risk (Agatston < 100), 15.1% at high risk (Agatston 100-399), and 8.9% at very high risk (Agatston ≥ 400). CAC scoring significantly reduced the number of individuals indicated for preventive treatment compared to SCORE (relative reduction women: 37.2%; men: 28.8%).
We showed that compared to risk stratification based on SCORE, CAC scoring classified significantly fewer men and women at increased risk, and less preventive treatment was indicated.
NTR6471.
通过筛查心血管疾病（CVD）高危人群并进行预防性治疗，可能会降低冠心病相关发病率和死亡率。ROBINSCA（风险或获益在 CVD 筛查中的评估）是一项基于人群的随机对照筛查试验，该试验使用系统性冠状动脉风险评估（SCORE）模型或冠状动脉钙评分（CAC 评分）对无症状参与者进行 CVD 筛查的有效性进行研究。本研究描述了 ROBINSCA 试验中风险和治疗的分布情况。
预计 CVD 风险升高的个体被随机分配到筛查组 A（n=14478；SCORE，10 年致死和非致死风险）或筛查组 B（n=14450；CAC 评分）。预防性治疗主要根据现行荷兰指南建议。分析了筛查组之间的风险和治疗差异。在组 A 中，有 12185 名（84.2%）参与者和组 B 中有 12950 名（89.6%）参与者接受了筛查。共有 48.7%为女性，中位年龄为 62（10 分位距 10）岁。SCORE 筛查发现 45.1%的低危人群（SCORE<10%）、26.5%的中危人群（SCORE 10-20%）和 28.4%的高危人群（SCORE≥20%）。根据 CAC 筛查，76.0%的人处于低危（Agatston<100），15.1%的人处于高危（Agatston 100-399），8.9%的人处于极高危（Agatston≥400）。与 SCORE 相比，CAC 评分显著减少了需要预防性治疗的人数（女性相对减少 37.2%；男性相对减少 28.8%）。
与基于 SCORE 的风险分层相比，CAC 评分显著减少了更多男性和女性处于高危状态的人数，且表明需要进行预防性治疗的人数减少。
NTR6471。
