%0 Journal Article
%T External validity of a cardiovascular screening including a coronary artery calcium examination in middle
%A Axel CP Diederichsen
%A Flemming H Steffensen
%A Hans Mickley
%A Jesper Hallas
%A Jess Lambrechtsen
%A Lars M Rasmussen
%A Mette H Grˋnhˋj
%A Michael H Olsen
%A Niels Peter R Sand
%A Oke Gerke
%J European Journal of Preventive Cardiology
%@ 2047-4881
%D 2018
%R 10.1177/2047487318774850
%X Coronary artery calcium is important in cardiovascular risk stratification, but this knowledge is based on studies with a significant selection bias. This study aims to evaluate the external validity of a screening programme including coronary artery calcium examination, and the association between coronary artery calcium and cardiovascular events. Multi-centre population based study. Randomly selected middle-aged men and women (Nˋ=ˋ1751) free of cardiovascular disease were invited to the examination during 2009每2010. Participation rate in the examination was 70%. Participants (nˋ=ˋ1227) and non-participants (nˋ=ˋ524) were compared regarding: cardiovascular medical treatment, Charlson comorbidity index and socioeconomic status (evaluated by cohabitation, gross income and education). Study endpoints were cardiovascular events and mortality. Non-participants had a significant higher comorbidity (pˋ=ˋ0.003) and a lower socioeconomic status (pˋ<ˋ0.0001), while cardiovascular medical treatment was alike. Over a median follow-up time of 6.5 years the cardiovascular event and mortality rates were equal (6.7% vs. 6.4%, pˋ=ˋ0.80 and 0.4% vs. 0.5%, pˋ=ˋ0.76, respectively). Adjusted hazard ratio was 0.90 (95% confidence interval (CI) 0.63每1.37). Among participants, the extent of coronary artery calcium was significantly associated with increased risk of cardiovascular events (hazard ratio 1.92, 95% CI 1.03每3.54, hazard ratio 3.66, 95% CI 1.82每7.32, hazard ratio 6.51, 95% CI 3.17每13.36 for coronary artery calcium scores 1每99, 100每399, ≡400 AU, respectively). Non-participants had a higher comorbidity index and a lower socioeconomic status, but the cardiovascular event and mortality rates were equal to those of participants. Thus, a screening programme including a coronary artery calcium examination had a high external validity regarding cardiovascular risk, but also a significant social imbalance
%K Coronary artery calcification
%K cardiovascular prevention
%K socioeconomic status
%K selection bias
%K cardiovascular disease
%U https://journals.sagepub.com/doi/full/10.1177/2047487318774850