ESC Study Express | Professor Zhao Dong interpret Dancavas Test: Study on External Push has great limitations

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At the annual meeting of the European Cardiology Association this year, the Danish cardiovascular disease screening random control test (Dancavas) announced the results of the five -year follow -up research for the first time, and published a detailed content of the research simultaneously at the New England Journal of Medicine. Professor Zhao Dong, Beijing Anzhen Hospital affiliated to Capital Medical University, interpreted the study.

The main purpose of DancavaS research is to evaluate whether the community population is generally used by CT to detect coronary atherosclerotic meta -clinical lesions (as indicators with coronary calcification) and whether the aorta and iliacmoma tumors can be beneficial to reduce the total death and total death and the crowd's death and whether Risk of cardiovascular disease incident. However, opposite to expectations, this highly watched research is negative result. The conclusion is that the screening of cardiovascular disease based on the use of imaging has no effect on the 5 -year mortality rate.

So far, many domestic and foreign cardiovascular disease prevention guidelines, including the "First -level Prevention Guide of Cardiovascular Diseases", have listed coronary calcification points as risk enhanced factors of atherosclerotic hardening cardiovascular disease (ASCVD). In order to increase the accuracy of the traditional hazardous assessment tools to identify high -risk groups, it will help correct treatment decisions; many scholars call on the application of further attention and expanding the evaluation of coronary calcification points in ASCVD level prevention. However, the lack of coronal clinical lesions to detect evidence of random control test research on the outcome of cardiovascular disease.

Does Dancavas study the results of the CT screening of coronary calcification lesions and evaluation lack of application value? The author believes that the results of this research cannot answer this question.

Expert interpretation

First of all, the main role of screening coronal clinical lesions is to promote the recognition of high -risk people to prevent high -risk groups, and to interfere with dangerous factors as soon as possible. Men who are more than 70 are basically high -risk groups of ASCVD. Therefore, the screening of coronary calcification lesions in the age of 70 lacks necessity. DancavaS studies the selected group of men aged 65-74, and the larger percentage of people are over 70 years old.

The Asian group analysis also found that the screening among people over the age of 70 has no effect on the ending of the total death (HR = 1.01, P = 0.74), but in the relatively young 65-69 years old The rate is obviously lower than those who have not received the screening. (HR = 0.89 p = 0.004) This reminder of the beneficiaries of coronary calcification points evaluation are mainly people under the age of 70.

Secondly, Denmark is a country where ASCVD is prevented. It is a country with low risk of cardiovascular disease in Europe and a free medical treatment for the whole people. Therefore, Dancavas studies whether the ratio of the selection of the screening or the selected group who has not received the screening is high. After the screening, the intervention measures adopted by people with higher coronary calcification points after screening are just recommended antrocomplitude, lipid lowering and lifestyle guidance.

Researchers are likely to overestimate the probability of studying the outcome of positive research on samples. Even so, this study still found that the screening of image learning of cardiovascular disease has a clear effect on reducing stroke and the risk of combining endpoints including total death, stroke, and myocardial infarction.

Therefore, the author believes that the exterior of this study design has great limitations. CT screening coronary pulse hardened sub -clinical lesions can still be widely used, especially for further evaluation, especially for the danger of cardiovascular disease in young and middle -aged people, the value, expenses and safety of the prognosis and improvement of prognosis.

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