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Cited by 183Health Promotion and Cardiovascular PreventionCardiac Imaging and DiagnosticsHealthcare Systems and Public Health

Five-year outcomes of the Danish Cardiovascular Screening (DANCAVAS) trial

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Lindholt, Jes S., Søgaard, Rikke, Rasmussen, Lars M., Mejldal, Anne, Lambrechtsen, Jess, Steffensen, Flemming H., Frost, Lars, Egstrup, Kenneth +3 more·2022·New England Journal of Medicine
DOI 10.1056/nejmoa2208681
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Abstract

BACKGROUND: Limited data suggest a benefit of population-based screening for cardiovascular disease with respect to the risk of death. METHODS: We performed a population-based, parallel-group, randomized, controlled trial involving men 65 to 74 years of age living in 15 Danish municipalities. The participants were randomly assigned in a 1:2 ratio to undergo screening (the invited group) or not to undergo screening (the control group) for subclinical cardiovascular disease. Randomization was based on computer-generated random numbers and stratified according to municipality. Only the control group was unaware of the trial-group assignments. Screening included noncontrast electrocardiography-gated computed tomography to determine the coronary-artery calcium score and to detect aneurysms and atrial fibrillation, ankle-brachial blood-pressure measurements to detect peripheral artery disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolemia. The primary outcome was death from any cause. RESULTS: A total of 46,611 participants underwent randomization. After exclusion of 85 men who had died or emigrated before being invited to undergo screening, there were 16,736 men in the invited group and 29,790 men in the control group; 10,471 of the men in the invited group underwent screening (62.6%). In intention-to-treat analyses, after a median follow-up of 5.6 years, 2106 men (12.6%) in the invited group and 3915 men (13.1%) in the control group had died (hazard ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00; P = 0.06). The hazard ratio for stroke in the invited group, as compared with the control group, was 0.93 (95% CI, 0.86 to 0.99); for myocardial infarction, 0.91 (95% CI, 0.81 to 1.03); for aortic dissection, 0.95 (95% CI, 0.61 to 1.49); and for aortic rupture, 0.81 (95% CI, 0.49 to 1.35). There were no significant between-group differences in safety outcomes. CONCLUSIONS: After more than 5 years, the invitation to undergo comprehensive cardiovascular screening did not significantly reduce the incidence of death from any cause among men 65 to 74 years of age. (Funded by the Southern Region of Denmark and others; DANCAVAS ISRCTN Registry number, ISRCTN12157806.).

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Crossref · 10.1056/nejmoa2208681

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  • Earlier onset of metabolic risk factors is associated with increased risk for CVD and mortality, motivating the timely identification and treatment of risk factors.

    “Earlier onset of metabolic risk factors is associated with increased risk for CVD and mortality, motivating the timely identification and treatment of risk factors.47–49”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [49]

    The introduction (pp. 2–3) presents early detection and preventive intervention as ways to reduce cardiovascular events, and the screening methods (p. 3) include tests for diabetes and high cholesterol. The paper does not establish the claimed association between earlier onset of metabolic risk factors and increased cardiovascular disease or mortality risk; its age comparison in the Discussion (p. 7) concerns age at screening, not age at risk-factor onset. (LLM, conf=0.84)

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  • The ICER for GLP-1-based therapies varied widely based on the cost of therapy and the comparator chosen.

    “However, the ICER varied widely based on the cost of therapy and the comparator chosen.49”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [49]

    The Outcomes section (p. 5) says cost-effectiveness was not reported in this paper. Searches for GLP-1 therapies, ICERs, therapy costs, and comparators found no passage addressing the claimed variation. (LLM, conf=0.78)

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  • Both SGLT2i and GLP-1-based therapy improve kidney outcomes, with GLP-1-based therapy additionally promoting significant weight reduction and glycemic control (especially semaglutide and tirzepatide) and reducing liver fibrosis in MASH.

    “Both SGLT2i and GLP-1–based therapy improve kidney outcomes,49–51 with GLP-1–based therapy additionally promoting significant weight reduction and glycemic control (especially semaglutide and tirzepatide)19–25 and reducing liver fibrosis in MASH”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [49]

    The Outcomes section (p. 5) describes cardiovascular-screening endpoints and medication use, not kidney outcomes from SGLT2 inhibitors or GLP-1–based therapy. Searches for those therapies, semaglutide, tirzepatide, and MASH found no passage addressing the attributed treatment effects. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • Sedentary behavior is an independent predictor of MASLD and is associated with a high risk for MASLD progression.

    “Finally, sedentary behavior is an independent predictor of MASLD and is associated with a high risk for MASLD progression.49,50”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [49]

    The Participants section (p. 6) lists cardiovascular screening findings, and the Discussion (p. 7) addresses mortality after screening. Neither addresses sedentary behavior as a predictor of MASLD or its progression; additional searches for MASLD, sedentary behavior, and fatty liver found no relevant passage. (LLM, conf=0.78)

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  • In a recently published RCT involving men aged 65-74 years, routine CVD screening did not significantly reduce the incidence of death from any cause after a median follow-up of 5.6 years, also in a pre-specified diabetes sub-group.

    “Moreover, in a recently published RCT involving men aged 65-74 years, routine CVD screening did not significantly reduce the incidence of death from any cause after a median follow-up of 5.6 years, also in a pre-specified diabetes sub-group.296”

    From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [296]

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Authors
Lindholt, J. S., Søgaard, R., Rasmussen, L. M., Mejldal, A., Lambrechtsen, J., Steffensen, F. H., Frost, L., Egstrup, K., Urbonaviciene, G., Busk, M., & Diederichsen, A. C. P.
Affiliations
  • University of Southern Denmark (DK)
  • From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) — all in Denmark.
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2022-10-13
Volume
387
Issue
15
Pages
1385-1394
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa2208681
OpenAlex
W4293872316
Semantic Scholar
e45554186343dbbd4336d0fe7a98a8b8783cffbe
Cited by
182
References
13
Citations by year
2026: 34 · 2025: 53 · 2024: 39 · 2023: 42 · 2022: 12 · 2021: 1
FWCI
32.23
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
Funders
  • Hjerteforeningen
  • Danish Independent Research Councils
  • Helsefonden
  • Odense Universitetshospital
  • Region of Southern Denmark
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
cardiovascular screening, coronary artery calcium score, aortic aneurysm, atrial fibrillation, peripheral arterial disease, hypertension, diabetes mellitus, hypercholesterolemia, all-cause mortality, stroke, myocardial infarction, aortic dissection, aortic rupture
MeSH terms
Aged, Calcium, Cardiovascular Diseases, Denmark, Humans, Male, Mass Screening, Incidence, Cardiac-Gated Imaging Techniques, Peripheral Arterial Disease

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