August 29, 2017
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VIVA: Screening for PAD, AAA, hypertension reduces mortality in older men

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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.