Section snippets

Methods

The VIVA (Viborg Vascular) trial is a population-based, randomized controlled trial of men age 65 to 74 years, who were randomized 1:1 to vascular screening or to no screening. Allocation was based on computer-generated random numbers and stratified into 19 municipalities. Only the control group was masked. In VIVA, AAA was defined as an aortic diameter ≥30 mm measured by 2-dimensional ultrasonography. Ankle-brachial index measurement was used to screen for peripheral artery disease and

Results

From October 2008 to January 2011, 50,156 participants were randomized with 25,078 in each group. Three participants in the invited group were lost to follow-up. Of those invited, 74.6% attended screening. Baseline characteristics varied across control subjects, attenders, and nonattenders: antiplatelet agents (29.6%, 29.3%, 31.5%; P = 0.004); lipid-lowering agents (35.3%, 36.4%, 33.0%; P < 0.001); antidiabetics (10.1%, 8.6%, 13.2%; P < 0.001); and hospitalizations for ischemic stroke (3.0%,

Discussion

The effectiveness of screening for AAA has been questioned owing to the declining prevalence and mortality of AAA. Nevertheless, this current secondary analysis of the VIVA trial shows that screening still significantly prevents AAAs from rupturing by 38%. Despite this benefit, there is a trade-off in the form of mortality owing to elective repair. Although AAA-specific mortality was reduced by 37%, the decrease did not reach significance (P = 0.061). Considering the changing epidemiology, with

Conclusions

Screening for AAA still seems efficient in the era after the changing epidemiology, but the focus must be on general cardiovascular prevention and nonattenders.

Funding Support and Author Disclosures

This work was supported by the 7th European Framework Program, Central Denmark Region, Viborg Hospital, and The Danish Council for Independent Research. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

中文翻译：

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筛查腹主动脉瘤仍可预防破裂：VIVA 试验的二次分析

 部分片段

 方法

VIVA （Viborg Vascular） 试验是一项基于人群的随机对照试验，受试者年龄在 65 至 74 岁之间，他们被 1：1 随机分配到血管筛查组或不进行筛查。分配基于计算机生成的随机数，并分为 19 个城市。只有对照组被蒙蔽。在 VIVA 中，AAA 定义为通过 2 维超声测量的主动脉直径 ≥30 mm。踝肱指数测量用于筛查外周动脉疾病和

 结果

从 2008 年 10 月到 2011 年 1 月，随机分配了 50,156 名参与者，每组 25,078 名参与者。受邀组中的 3 名参与者失访。在受邀者中，74.6% 参加了筛查。基线特征因对照受试者、参加者和不参加者而异：抗血小板药物 （29.6%、29.3%、31.5%;P = 0.004）;降脂药 （35.3%， 36.4%， 33.0%;P < 0.001）;抗糖尿病药 （10.1%， 8.6%， 13.2%;P < 0.001）;和缺血性中风住院 （3.0%，

 讨论

由于 AAA 的患病率和死亡率下降，筛查 AAA 的有效性受到质疑。尽管如此，目前对 VIVA 试验的二次分析表明，筛查仍然显着防止 AAAs 破裂 38%。尽管有这种好处，但由于选择性修复，存在死亡率形式的权衡。尽管 AAA 特异性死亡率降低了 37%，但下降并未达到显着性 （P = 0.061）。考虑到不断变化的流行病学，随着

 结论

在流行病学发生变化后的时代，AAA 筛查似乎仍然有效，但重点必须放在一般心血管预防和无人值守上。

资金支持和作者披露

这项工作得到了第 7 个欧洲框架计划、丹麦中部地区、Viborg 医院和丹麦独立研究委员会的支持。作者报告说，他们与本文的内容没有要披露的关系。