External validity of a cardiovascular screening including a coronary artery calcium examination in middle-aged individuals from the general population

Mette H. Grønhøj, Oke Gerke, Hans Mickley, Flemming H. Steffensen, Jess Lambrechtsen, Niels Peter R. Sand, Lars M. Rasmussen, Michael H. Olsen, Jesper Hallas, Axel C.P. Diederichsen*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstrakt

Background: Coronary artery calcium is important in cardiovascular risk stratification, but this knowledge is based on studies with a significant selection bias. This study aims to evaluate the external validity of a screening programme including coronary artery calcium examination, and the association between coronary artery calcium and cardiovascular events. Design: Multi-centre population based study. Methods: Randomly selected middle-aged men and women (N = 1751) free of cardiovascular disease were invited to the examination during 2009–2010. Participation rate in the examination was 70%. Participants (n = 1227) and non-participants (n = 524) were compared regarding: cardiovascular medical treatment, Charlson comorbidity index and socioeconomic status (evaluated by cohabitation, gross income and education). Study endpoints were cardiovascular events and mortality. Results: Non-participants had a significant higher comorbidity (p = 0.003) and a lower socioeconomic status (p < 0.0001), while cardiovascular medical treatment was alike. Over a median follow-up time of 6.5 years the cardiovascular event and mortality rates were equal (6.7% vs. 6.4%, p = 0.80 and 0.4% vs. 0.5%, p = 0.76, respectively). Adjusted hazard ratio was 0.90 (95% confidence interval (CI) 0.63–1.37). Among participants, the extent of coronary artery calcium was significantly associated with increased risk of cardiovascular events (hazard ratio 1.92, 95% CI 1.03–3.54, hazard ratio 3.66, 95% CI 1.82–7.32, hazard ratio 6.51, 95% CI 3.17–13.36 for coronary artery calcium scores 1–99, 100–399, ≥400 AU, respectively). Conclusions: Non-participants had a higher comorbidity index and a lower socioeconomic status, but the cardiovascular event and mortality rates were equal to those of participants. Thus, a screening programme including a coronary artery calcium examination had a high external validity regarding cardiovascular risk, but also a significant social imbalance.

OriginalsprogEngelsk
Sider (fra-til)1156-1166
Antal sider11
TidsskriftEuropean Journal of Preventive Cardiology
Vol/bind25
Udgave nummer11
DOI
StatusUdgivet - 1 jul. 2018

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