In the JournalsPerspective

VIVA: Screening for PAD, AAA, hypertension reduces mortality in older men

A screening program for peripheral artery disease, abdominal aortic aneurysm and hypertension was associated with reduced mortality risk in men aged 65 to 74 years, researchers reported in The Lancet.

For the VIVA trial, the researchers randomly assigned 50,156 Danish men aged 65 to 74 years to receive screening for PAD, AAA and hypertension or to receive no screening.

Patients diagnosed with PAD or AAA returned for confirmation and to be started on medical therapy, and patients diagnosed with AAA were offered annual control or surgical/endovascular repair. Patients diagnosed with hypertension were referred to their general practitioner for management.

The primary outcome was all-cause mortality at 5 years.

At a median follow-up of 4.4 years, 10.2% of those in the screening group and 10.8% of those in the control group had died (HR = 0.93; 95% CI, 0.88-0.98).

This translated to an absolute risk reduction of 0.006 (95% CI, 0.001-0.011) and a number needed to invite of 169 to prevent one death, Jes. S. Lindholt, PhD, from the department of cardiothoracic and vascular surgery at Odense University Hospital, Odense, Denmark, and the Vascular Research Unit at Viborg Hospital, Viborg, Denmark, and Rikke Søgaard, PhD, from the departments of public health and clinical medicine at Aarhus University, Denmark, wrote.

The groups did not differ during the study period in onset of diabetes, intracerebral hemorrhage, renal failure, cancer or 30-day mortality after CV surgery, according to the researchers.

In a related editorial, Chadi Ayoub, MD, and M. Hassan Murad, MD, MPH, both from the Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, wrote that more research on this issue is needed in women, people of nonwhite race, younger people and people from low- and middle-income countries, and that more data are needed on the effects of interventions such as smoking cessation, lifestyle changes, AAA repair and the effects of surveillance.

“The VIVA trial presents thought-provoking findings. However, implementation of this screening intervention requires more proof than presented in this study,” they wrote.

The results were also presented at the European Society of Cardiology Congress.

by Erik Swain

Disclosure: The authors and editorial writers report that they have no relevant financial disclosures.

 

 

A screening program for peripheral artery disease, abdominal aortic aneurysm and hypertension was associated with reduced mortality risk in men aged 65 to 74 years, researchers reported in The Lancet.

For the VIVA trial, the researchers randomly assigned 50,156 Danish men aged 65 to 74 years to receive screening for PAD, AAA and hypertension or to receive no screening.

Patients diagnosed with PAD or AAA returned for confirmation and to be started on medical therapy, and patients diagnosed with AAA were offered annual control or surgical/endovascular repair. Patients diagnosed with hypertension were referred to their general practitioner for management.

The primary outcome was all-cause mortality at 5 years.

At a median follow-up of 4.4 years, 10.2% of those in the screening group and 10.8% of those in the control group had died (HR = 0.93; 95% CI, 0.88-0.98).

This translated to an absolute risk reduction of 0.006 (95% CI, 0.001-0.011) and a number needed to invite of 169 to prevent one death, Jes. S. Lindholt, PhD, from the department of cardiothoracic and vascular surgery at Odense University Hospital, Odense, Denmark, and the Vascular Research Unit at Viborg Hospital, Viborg, Denmark, and Rikke Søgaard, PhD, from the departments of public health and clinical medicine at Aarhus University, Denmark, wrote.

The groups did not differ during the study period in onset of diabetes, intracerebral hemorrhage, renal failure, cancer or 30-day mortality after CV surgery, according to the researchers.

In a related editorial, Chadi Ayoub, MD, and M. Hassan Murad, MD, MPH, both from the Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, wrote that more research on this issue is needed in women, people of nonwhite race, younger people and people from low- and middle-income countries, and that more data are needed on the effects of interventions such as smoking cessation, lifestyle changes, AAA repair and the effects of surveillance.

“The VIVA trial presents thought-provoking findings. However, implementation of this screening intervention requires more proof than presented in this study,” they wrote.

The results were also presented at the European Society of Cardiology Congress.

by Erik Swain

Disclosure: The authors and editorial writers report that they have no relevant financial disclosures.

 

 

    Perspective
    Mark Creager, MD

    Mark A. Creager

    The major takeaway from this study is that screening a population of men aged 65 to 74 years detected a significant number of patients with AAA, PAD or high BP. In those detected, many received appropriate treatment, and their mortality rate decreased.

    This is the first time that a screening examination, particularly one involving patients with PAD, has been shown to result in factorable outcomes for those who were screened.

    This has important implications. The American Heart Association/American College of Cardiology Clinical Practice Guidelines on PAD give a high-level recommendation for screening for PAD in high-risk individuals. But the recommendation had to be tempered somewhat, because up until now, we did not know whether screening would result in treatment that would favorably affect outcomes. This trial would support that notion.

    Other studies have shown efficacy of screening on outcomes for AAA and hypertension, but this trial now provides first evidence for PAD and gives us more impetus to screen men in this age group. If disease is found, an appropriate risk-factor modification therapy should be instituted.

    We have to be careful about extrapolating to other populations, but it is crucial to note that a screening test, which took a relatively short time to do and was noninvasive, resulted in new risk-factor modifying therapies including smoking cessation, aspirin use and statin use among patients who had not previously received them because their disease was unrecognized. That these steps effectively reduced the risk for death is a very important message.

    • Mark A. Creager, MD
    • Anna Gundlach Huber Professor in Medicine
      Geisel School of Medicine, Dartmouth
      Director, Heart and Vascular Center
      Dartmouth-Hitchcock Health System
      Past President, American Heart Association

    Disclosures: Creager reports he has no relevant financial disclosures.