- Design
- Prospective population-based cohort with propensity-matched controls, intention to invite
- Population
- 5,412 invited 67-year-olds and 16,236 matched controls in Denmark
- Primary outcome
- All-cause mortality
- Effect
- 6.9% vs 8.9%; HR 0.76 (95% CI 0.68–0.85); number needed to invite 49
The Viborg Screening Program invited every 67-year-old in a Danish region to screening for carotid plaque, peripheral artery disease, abdominal aortic aneurysm, hypertension, arrhythmia or ischaemia, and diabetes. Of 5,505 invited, 83.6% attended. Invitees were compared with 67-year-olds from areas without screening access, matched 1:3 by propensity score.
Over a median 5.8 years, 6.9% of invitees and 8.9% of controls died (HR 0.76, 95% CI 0.68–0.85), so about 49 people had to be invited to prevent one death. The effect held in men (HR 0.73) and in women (HR 0.82), a useful finding because earlier screening trials enrolled only men. It was seen in people without known cardiovascular disease (HR 0.70) but not in those who already had it (HR 0.97, 0.78–1.21).
Cardiovascular mortality fell by a similar proportion but the interval crossed 1.0 (HR 0.76, 0.56–1.03). Major adverse cardiovascular events were slightly more frequent among invitees (HR 1.10), which most likely reflects more disease found and recorded rather than harm.
This was not randomised, and matching cannot remove every difference between areas with and without screening. A mortality benefit larger than the cardiovascular death effect also raises the question of what else differed. Treat it as supportive evidence for organised screening in older adults without known disease, not as proof.
- In a 67-year-old with no known cardiovascular disease, consider a structured check of blood pressure, glucose, pulse rhythm, peripheral pulses and aortic risk.
- Patients who already carry a cardiovascular diagnosis gained no mortality signal from screening here; focus their visits on treatment.
- Expect more recorded events after screening; finding disease raises the count before it lowers it.
- Women benefited too, which earlier men-only screening trials could not show.
Why it matters
It extends the case for cardiovascular screening to women, where earlier trials were silent.
Don't overread it
This was a propensity-matched comparison, not a randomised trial, so unmeasured differences between areas could explain part of the effect.
The statistics, in plain English
A hazard ratio of 0.76 for all-cause death means about 24% fewer deaths among those invited. 'Number needed to invite' of 49 counts everyone offered screening, including non-attenders. The cardiovascular-death interval (0.56 to 1.03) crosses 1.0, so that result alone is not conclusive, and the sex and prior-disease splits were post hoc.
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