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June 3, 2020European Heart Journal - Cardiovascular ImagingOpen Access

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

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Why the study?

Screening for high CVD risk followed by preventive treatment may reduce morbidity and mortality, but the effectiveness of screening asymptomatic individuals using the SCORE model versus CAC scoring needed investigation.

Does cardiovascular disease screening using CAC scoring reduce the indication for preventive treatment compared to the SCORE model in asymptomatic individuals at elevated CVD risk?

Population

Asymptomatic individuals at expected elevated CVD risk (n = 14 478 in arm A, n = 14 450 in arm B)

Comparison

CAC scoring vs SCORE model screening

Design

Population-based randomized controlled screening trial

Key result

Coronary artery calcium scoring significantly reduced the number of individuals indicated for preventive treatment compared to SCORE screening (relative reduction 37.2% in women and 28.8% in men).

Authors

CACarlijn M. van der AalstSDSabine J A M DenissenMVMarleen Vonder

Discussion

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Overview

CAC screening classifies fewer asymptomatic adults as high-risk than SCORE; leaves open whether it reduces overtreatment or improves outcomes.

Study Design

Type

RCT (n=28,928)

Randomization

Randomized

Structured PICO

Does cardiovascular disease screening using CAC scoring reduce the indication for preventive treatment compared to the SCORE model in asymptomatic individuals at elevated CVD risk?

P
Population
28,928 asymptomatic individuals at expected elevated cardiovascular disease risk (median age 62 years, 48.7% women) randomized to screening via SCORE or CAC scoring.
I
Intervention
Cardiovascular disease screening using coronary artery calcium (CAC) scoring (n=14,450)
C
Comparator
Cardiovascular disease screening using the Systematic COronary Risk Evaluation (SCORE) model (n=14,478)
O
Outcome
Distributions in risk classification and indication for preventive treatment

Main Result

Effect estimate: relative reduction women: 37.2%; men: 28.8%

In asymptomatic individuals at elevated CVD risk, screening with CAC scoring results in significantly fewer patients being indicated for preventive treatment compared to traditional SCORE risk assessment.

Cite This Study

Aalst et al. (2020) conducted an RCT in Elevated cardiovascular disease risk (n=28,928). Coronary artery calcium (CAC) scoring vs. Systematic COronary Risk Evaluation (SCORE) model was evaluated on Indication for preventive treatment (relative reduction women: 37.2%; men: 28.8%). Coronary artery calcium scoring significantly reduced the number of individuals indicated for preventive treatment compared to SCORE screening (relative reduction 37.2% in women and 28.8% in men).

synapsesocial.com/papers/6a50393373bacd73dc78447chttps://doi.org/10.1093/ehjci/jeaa168
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prevention of sudden death: the role of coronary artery calcification imaging in preventive cardiology2020
  2. 2Risk or Benefit in Screening for Cardiovascular Disease (ROBINSCA): The Rationale and Study Design of a Population-Based Randomized-Controlled Screening Trial for Cardiovascular Disease2019 · 17 citations
  3. 3Impact of a cardiovascular disease risk screening result on preventive behaviour in asymptomatic participants of the ROBINSCA trial2019 · 38 citations
  4. 4Pre-screening to guide coronary artery calcium scoring for early identification of high-risk individuals in the general population2022 · 14 citations
  5. 5Screening for coronary artery calcium in a high-risk population: the ROBINSCA trial2020 · 13 citations