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Why and when to screen for cardiovascular disease in healthy individuals
  1. Jes Sanddal Lindholt1,
  2. Rikke Søgaard1,2
  1. 1 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Elitary Research Centre for Individualized Medicine in Arterial Disease (CIMA), University of Southern Denmark, Odense, Denmark
  2. 2 Advisory Board Regarding the National Screening Programmes, Danish National Board of Health, Copenhagen, Denmark
  1. Correspondence to Dr Jes Sanddal Lindholt, Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre for Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense 5000, Denmark; Jes.Sanddal.Lindholt{at}rsyd.dk

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Learning objectives

  1. Why screen for cardiovascular disease?

  2. When is screening justified?

  3. Proposed cardiovascular screening programmes.

  4. The rationale, need and opportunity of multiple screening.

The societal challenge of the ageing population

Although the incidence of cardiovascular disease (CVD) has decreased in recent decades, CVD remains a major healthcare challenge. In Europe alone, CVD causes 3.9 million deaths annually (45% of all deaths), and due to the demographic shift toward a more elderly it will continue to increase its prevalence.1 2 In 2015, almost 49 million Europeans were living with CVD, corresponding to slightly less than 10% of the population. This fact translates into annual losses of 26 million disability-adjusted life years (QALYs) and annual costs to society of approximately €210 billion, half of which is in healthcare costs.1

Remarkably, 80% of cardiac events and strokes are preventable and 25%–75% of these are through early detection and intervention.1 3 Therefore, strategies to prevent ischaemic events offer some of the greatest potential for improving public health. The uniform natural history and prevention of manifest atherosclerosis provides the possibility for much larger benefits than seen in cancer screening programmes due to the initiation of uniform cardiovascular preventive actions, when localised lesions are detected—also protects unidentified remote lesions.4–9 Thus, the development of new proposals for screening approaches is rapidly evolving, and influential bodies such as the US Preventive Services Task Force (USPSTF) and the UK National Screening Committee (UK NSC) have evaluated a number of proposals for cardiovascular screening and, as a result, currently recommend screening for a variety of individual conditions.

Prevention of cardiovascular atherosclerotic disease

Primary prevention

Primary prevention is the intervention against the modifiable risk factors of ischaemic events. Global risk scores such as the SCORE are recommended to combine individual risk factors into a single quantitative risk estimate.10–12

In Europe and USA, individuals with a 10-year risk of CVD death ≥5% qualify for lifestyle intervention and, …

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Footnotes

  • Contributors Both authors contributed equally to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.

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