AAA, PAD, High BP Mortality Reduced by Triple Screening

Triple screening of older men for abdominal aortic aneurysm (AAA), peripheral arterial disease (PD), and hypertension resulted in a 7% reduction in 5-year mortality, according to results presented at the European Society of Cardiology (ESC) Congress in Barcelona.

The Viborg Vascular (VIVA) trial, led by Jes Lindholt (pictured), DMSci, PhD, of Odense University Hospital in Denmark and Rikke Søgaard, MD, of Aarhus University in Denmark, examined a patient population of 50,156 men aged 65 to 74 that were randomized to either no screening or triple screening groups.

Previous studies have shown that 6% of men older than 65 have AAA, a significantly higher rate than women, leading the study authors to exclude women from the trial.

"We believe that this improvement is primarily explained by the 2.5-times higher incidence of elective aneurysm repairs and the doubled initiation rates of antithrombotic and lipid-lowering therapy in the group invited to screening," Lindholt said in a statement.

Half of the men (n=18748) were randomized to receive triple screening, which was carried out by 2 trained nurses in a 10-minute session. An AAA of 30 mm or more was found in 3.3% of men (n=616), 0.3% having an AAA larger than 5.4 cm (n=61). The men that tested with an AAA larger than 5.5 cm were referred to a CT scan.

PAD (ankle-brachial index of <0.9 or >1.4) was diagnosed in 11% of the men, while moderate to severe hypertension (>160/100 mm Hg) was detected in 10.5%.

The 2506 men that were diagnosed with AAA or PAD were retested and given a cholesterol blood test. The results showed that 37% had total cholesterol of >4 mmol/L, with 46% surveying that they were receiving sufficient medical prevention.

Men who tested with possible hypertension were referred to a general practitioner to confirm the diagnosis and review antihypertension therapy.

After a median 4.4-year follow up, 10.2% (n=2566) of the men had died in the screened group, compared to 10.8% (n=2715) in the non-screened group.

"After 5 years we found that this simple vascular screening effort reduces overall mortality by 7%, with a number needed to invite as low as 169 to prevent one death within 5 years," Lindholt said.

Whether or not to treat AAA or PAD with low-dose aspirin and/or statins has been a topic of contention, according to the authors. However, the clinical implications of the findings are that AAA and PAD patients should receive statins and antiplatelets, Linholt said.

The VIVA trial helped point out an underestimation of PAD by the medical community, something the COMPASS trial, also presented at the ESC Congress was quick to highlight.

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