Cardiovascular diseases account for 31% of deaths in men under 70 years of age. In the DANCAVAS 1 trial, a cardiovascular screening program based on computed tomography (CT) did not reduce all-cause mortality in men aged 65 to 74, except in the subgroup aged 65 to 69, where a significant 11% reduction was observed. Building on this background, the DANCAVAS 2 study evaluated the impact of screening in men aged 60 to 64.
This was a randomized, controlled clinical trial including 31,268 men aged 60 to 64. Of these, 5,946 were invited to screening and 25,322 were not invited. The program consisted of non-contrast CT (to detect coronary calcium, atrial fibrillation, and aortic/iliac aneurysms), blood pressure measurement in four limbs (to identify peripheral artery disease and hypertension), and blood tests (to detect diabetes mellitus and hypercholesterolemia). The primary endpoint was all-cause mortality; secondary endpoints included cardiovascular mortality, myocardial infarction, stroke, revascularization, or lower-limb amputation, in addition to major bleeding as a safety outcome. The median follow-up was 7 years.
All-cause mortality occurred in 555 patients (9.33%) in the invited group vs 2,509 (9.91%) in the non-invited group, with no significant difference (p=0.169). Major cardiovascular events (cardiovascular mortality, stroke, or myocardial infarction) also showed no differences (HR 0.96; 95% CI 0.88–1.04; p=0.319). Among participants who actually attended screening and adhered to preventive treatment, a relative reduction in mortality of 17% (95% CI 2–29%) was observed, equivalent to an absolute reduction of 0.9%, but at the cost of an absolute increase of 1.4% in major bleeding (relative increase of 37%; 95% CI 16–61%).
Read also: ESC 2025 | DUAL-ACS: Duration of Dual Antiplatelet Therapy in Acute Coronary Syndromes.
The authors concluded that, after seven years of follow-up, invitation to a cardiovascular screening program in men aged 60 to 64 did not reduce all-cause mortality and was associated with a significant increase in major bleeding, suggesting a possible harmful effect of aspirin use even in patients with subclinical coronary atherosclerosis.
Presented by Axel Diederichsen in Major Late Breaking Trials, ESC 2025, Madrid, España.
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