TY - JOUR
T1 - Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium scoring
T2 - the ROBINSCA trial
AU - van der Aalst, Carlijn M
AU - Denissen, Sabine J A M
AU - Vonder, Marleen
AU - Gratama, Jan Willem C
AU - Adriaansen, Henk J
AU - Kuijpers, Dirkjan
AU - Vliegenthart, Rozemarijn
AU - van Lennep, Jeanine E Roeters
AU - van der Harst, Pim
AU - Braam, Richard L
AU - van Dijkman, Paul R M
AU - van Bruggen, Rykel
AU - Oudkerk, Matthijs
AU - de Koning, Harry J
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Aim 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.Methods and results 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%).Conclusion 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.
AB - Aim 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.Methods and results 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%).Conclusion 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.
KW - Cardiovascular disease
KW - Computed tomography imaging
KW - Coronary artery calcification
KW - Population-based screening
KW - Risk prediction
KW - ROBINSCA trial
KW - ATHEROSCLEROSIS
KW - QUANTIFICATION
KW - CLASSIFICATION
KW - IMPROVEMENT
KW - PERCEPTION
KW - MANAGEMENT
KW - MARKERS
KW - EVENTS
KW - SCORES
U2 - 10.1093/ehjci/jeaa168
DO - 10.1093/ehjci/jeaa168
M3 - Article
C2 - 32584979
VL - 21
SP - 1216
EP - 1224
JO - European Heart Journal - Cardiovascular Imaging
JF - European Heart Journal - Cardiovascular Imaging
SN - 2047-2404
IS - 11
ER -