Judicious CVD Screening May Work in Men: DANCAVAS
Medicine excels when we treat people who ask for our help. Preventing people from needing our help is much tougher. The DANCAVAS trial, presented at the European Society of Cardiology (ESC) meeting and published in the New England Journal of Medicine, did not shy away from this high bar.
DANCAVAS: A Unique Trial
DANCAVAS was a population-based randomized trial of 45,000 men aged 65 to 74 years from 15 municipalities in Denmark. Researchers randomly assigned one third of them to an invitation to attend comprehensive cardiovascular disease (CVD) screening and two thirds to no invitation. Of those invited to screening, only 63% attended. The main comparison was between the invited and uninvited men.
The screening process was unique. Primary investigator Axel Diederichsen told me that all screening was done in one session and took about 40 minutes per person. Sessions were usually scheduled after clinic hours from 4 PM to 8 PM twice a week.
On arrival to screening, participants completed a questionnaire and then had their height, weight, and blood pressures in both upper and lower extremities (ankle-brachial index) measured. They then underwent CT starting at the jaw and panning down to the femoral region. The scans assessed only for coronary calcium and aortic aneurysms. A rhythm strip was taken during the scan. The patient then had blood drawn for lipids and glucose.
If there were no abnormalities, participants were informed by regular mail. Those who had abnormalities attended follow-up visits and were offered lifestyle recommendations, smoking cessation advice, medications (including aspirin, statins, and anticoagulants), and vascular surgery. Follow-up via the national Danish health registry was planned for 10 years. This report was the 5-year update.