New Cardiovascular Risk Screening Strategy.
- Conditions
- ArteriosclerosisAsymptomaticPeripheral Artery DiseaseCardiovascular PreventionScreening
- Interventions
- Diagnostic Test: HELENA
- Registration Number
- NCT05884840
- Lead Sponsor
- Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina
- Brief Summary
Mortality due to cardiovascular disease (CVD) in Spain accounted for 29% of all deaths (32% in women and 26% in men) in 2017. Out of those, 67% were related to a coronary or a cerebrovascular disease .
A key strategy in primary prevention of CVD is to use risk functions to individualize preventive interventions for each patient. The current CV risk-screening program in some regions of Spain, is based using an adapted Framingham scale, REGICOR's risk function, which is integrated in the primary care electronic health record. This risk function predicts the probability within 10 years of developing a coronary event. However, this function fails to identify patients that fall into low- or intermediate-risk level, and might develop a CV event in the up following 10 years.
Ankle-brachial index (ABI) is a simple, non-invasive and economic technique, which allows detecting peripheral arterial disease (PAD), and gives independent risk function information compared to other coronary risk functions. Even tough, between 13-27% of middle age population have an ABI ≤ 9, around 50-89% of them do not exhibit any symptoms. However, they hold higher mortality risk and CV events. Current clinical guidelines for PAD screening, have a limited level of evidence, and only recommend using ABI on patients aged 50-70, who have diabetes or are smokers, and patients older than 70 years old.
A new risk function, REASON, to assess CVD risk has been designed. This model has proven to improve predictive capacity of holding an ABI ≤ 0.9 on those patients aged 50-74 that are apparently free of CVD. Therefore, a strategy that combines the current CV risk estimation using REGICOR, and the prediction capacity of pathologic ABI with REASON, would allow detecting high-risk patients with a PAD screening program. It is possible that patients, who hold an ABI ≤ 0.9, even if being asymptomatic, will adopt physician's recommendations on healthy life habits and preventive treatment.
The aims of this study are:
* To assess the effectiveness and cost-utility of adding a screening program with ABI to the current strategy of CV risk detection to reduce the incidence of CVD and mortality from all causes in the population aged 50 to 74.
* To assess the effectiveness of adding a screening program with ABI to the current strategy of CV risk detection to improve cardiovascular risk factors in the population aged 50 to 74.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 54000
- Patients aged 50 to 74, which are free or do not have previous history of CVD. Patients that hold a REGICOR CV risk score ≥7, and REASON risk core ≥7, during a routine primary care visit
- Symptomatic PAD
- Coronary disease
- Stroke
- Cardiac revascularization
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group PAD screening program HELENA Patients aged 50-74 years free of any symptomatic or history of CVD and a Framingham-REGICOR risk ≥7%, will be candidates for PAD screening program using REASON's function predicative capacity
- Primary Outcome Measures
Name Time Method Proteinuria (CVD risk factors improvement assessment) 3 years mg/dL protein in urine
Lipid profile (CVD risk factors improvement assessment) 3 years Total cholesterol (mg/dl), LDL (mg/dl), HDL (mg/dl), Triglycerides (mg/dl)
Systolic and diastolic pressure (CVD risk factors improvement assessment) 3 years mm Hg
Weight (CVD risk factors improvement assessment) 3 years kg
Height (CVD risk factors improvement assessment) 3 years m
Hard coronary heart disease (CHD) 3 years Myocardial infarction, cardiac revascularization, or coronary death
Major adverse cardiovascular event (MACE) 3 years A composite of hard CHD (myocardial infarction, cardiac revascularization, or coronary death) and stroke (fatal and nonfatal ischemic stroke)
All-cause mortality 3 years Tabaco consumption (CVD risk factors improvement assessment) 3 years Smoker, ex-smoker or non-smoker
BMI (CVD risk factors improvement assessment) 3 years (kg/m2) Will be calculated dividing the weight in kilograms by their height in metres squared
Glycaemia (CVD risk factors improvement assessment) 3 years Fasting blood sugar (mg/dl)
Albumin-to-creatinine ratio (ACR) (CVD risk factors improvement assessment) 3 years ACR (mg/g) will be calculated by by dividing mg of proteinuria (albumine) by g of creatinine.
Glomerular filtrate rate (CVD risk factors improvement assessment) 3 years Levels of creatinine in milliliters of cleansed blood per minute per body surface (mL/min/1.73m2).
Glycated haemoglobin (CVD risk factors improvement assessment) 3 years (in DM patients) glycosylated hemoglobin in the blood (mg/dl) or percentage (%)
Creatinine (CVD risk factors improvement assessment) 3 years mg/dL
- Secondary Outcome Measures
Name Time Method Lipid lowering medication Adverse effects 3 years 1) Short-term effects: Muscular and hepatic alterations, and 2) long-term effects: Diabetes and cancer
Coronary heart disease 3 years A composite of angina and hard CHD
Cerebrovascular disease 3 years A composite of stroke (fatal and nonfatal ischemic stroke) and transient ischemic attack
Cardiovascular disease 3 years a composite of MACE, angina and transient ischemic attack
Trial Locations
- Locations (1)
Institut Català de la Salut (ICS)
🇪🇸Barcelona, Spain