Effectiveness of Screening Postmenopausal Women for Cardiovascular Diseases: A Population Based, Prospective Parallel Cohort Study

Publication date: Available online 4 April 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Marie Dahl, Rikke Søgaard, Lars Frost, Annette Høgh, Jes Lindholt
ObjectivesTo investigate the effectiveness of systematic screening for multifaceted cardiovascular disease (CVD) in postmenopausal women on all cause mortality and, secondarily, on CVD morbidity. Effectiveness was also evaluated across age strata.MethodsThis was a population based, prospective, parallel cohort study. In total, 107,491 women born in 1936–1951 living in the Central Denmark region were identified in the Danish Civil Registration System. From this population, all women born in 1936, 1941, 1946, and 1951 (n = 1984) living in the Viborg municipality were invited to attend screening. Of those invited to the screening, 1474 (74.3%) attended. The control group included all women from the general population born in 1936–1951 and living in the Central Denmark Region, excluding those invited for the screening. Information on medication and comorbidities prior to inclusion and study outcomes were retrieved from national registries for both groups. The screening included examination for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), potential hypertension (HT), atrial fibrillation (AF), diabetes mellitus (DM), and dyslipidaemia. The adjusted Cox proportional hazards model with the intention to screen principle was used to assess effectiveness for the total population and across age groups.ResultsDuring follow up (median 3.3 years, IQR 2.9–3.9), the adjusted hazard ratios (HRs) for invited versus controls were the following: all cause mortality, 0.89 (95% CI 0.71–1.12); myocardial infarction (MI), 1.26 (95% CI 0.52–3.07); ischaemic heart disease (IHD), 0.72 (95% CI 0.49–1.05); PAD, 1.07 (95% CI 0.49–2.31); and ischaemic stroke, 1.20 (95% CI 0.78–1.85). A substantial number of women with AAA, PAD, and/or CP declined prophylactic therapy: 45% for antiplatelet and 35% for cholesterol lowering agents.ConclusionsThis multifaceted screening offer to a general population sample of postmenopausal women had no effects on all cause mortality or hospital admission for MI, IHD, PAD, and stroke within a short-term follow up period.



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