In 2024, 1.4 billion adults worldwide had high blood pressure and 44% did not know it. A useful cardiovascular work-up starts with blood pressure, lipids, blood glucose, smoking and family history; scans and advanced markers come afterwards, and only if they can change what is actually done.
Family history, risk factors, or simply a doubt? Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
What a large Danish screening trial shows
DANCAVAS is a large Danish trial that invited 46,611 men aged 65 to 74 to very broad cardiovascular screening. After 5.6 years, 12.6% of the men in the invited group had died, against 13.1% in the control group: the gap was not statistically conclusive. The message for a patient is therefore not to scan everything, but to identify the risks that can genuinely be corrected.
A targeted cardiovascular work-up remains useful for picking up high blood pressure, diabetes, raised cholesterol, smoking or a family risk. The more advanced tests, calcium score, coronary CT, ultrasound or functional testing, are then chosen according to symptoms and level of risk.
The calcium score: useful for refining risk, not for predicting the future on its own
The coronary calcium score is probably the most studied marker of the past decade. It measures the amount of calcium in the heart arteries, on a CT scan without contrast.
| What is measured | The result |
|---|---|
| Improvement in risk reclassification over classical factors, multi-ethnic cohort | Net reclassification index of 0.25, the best of all markers tested |
| Comparison with high-sensitivity C-reactive protein, in the same cohort | The calcium score clearly outperforms the blood markers tested |
| Randomised trials measuring an effect of the calcium score on mortality | None |
| What the measurement changes in practice | It moves patients from one risk category to another, therefore a treatment decision |
A marker that reclassifies well is not the same thing as a test shown to make people live longer. The first property is established, the second is not.
Coronary CT: benefits and limits must be read together
A Scottish trial randomised patients with stable chest pain between usual care and care including coronary CT. At 10 years, the result is this.
| The endpoint | The result at 10 years |
|---|---|
| Coronary death or non-fatal myocardial infarction, primary endpoint | Hazard ratio of 0.79, significant |
| Coronary death taken alone | Hazard ratio of 0.97, not significant |
| All-cause death | No difference demonstrated |
| What explains the benefit | A change in the preventive treatments prescribed after the scan, not the scan itself |
The benefit on the composite endpoint is real and it stems from better prescribing. But it must not be written that CT reduces coronary mortality, because on that precise endpoint the trial is neutral.
And there is a trade-off, measured in another trial. In patients without symptoms, systematic coronary exploration led to more invasive procedures with no demonstrated benefit, with a composite event rate of 2.1% against 1.6%, an odds ratio of 1.32 against the explored group. The gap was not significant, but it points the wrong way.
Lipoprotein(a): a risk marker, with no evidence that screening reduces mortality
Lipoprotein(a) is genetically determined, varies little across life, and its elevation is an established causal cardiovascular risk factor. In a large cohort, 12.2% of people tested have a value at or above 150 nmol/L.
Here is the difficulty we refuse to hide. No specific lipoprotein(a) lowering treatment has to date demonstrated a reduction in cardiovascular events. Phase 3 trials are running. Measuring this marker today informs about a risk, but does not open onto a targeted action. It can legitimately lead to treating the other factors more firmly, which is not nothing, but it must be put that way.
Atrial fibrillation: two trials, two different results
| The trial | What was tested | The result |
|---|---|---|
| 28,768 people aged 75 to 76, Sweden | Intermittent electrocardiogram over 2 weeks | Hazard ratio of 0.96 on the composite endpoint, p of 0.045 |
| 6,004 people at risk, Denmark | Continuous implantable cardiac monitor | Fibrillation detected 3 times more often, and yet p of 0.11 on stroke and embolism |
| What the comparison teaches | Detecting more is not preventing more | The second trial detects far better and demonstrates no benefit |
The first trial is positive by a hair, the second is negative despite far better detection. It is the clearest illustration that a more sensitive test is not automatically a more useful one.
Abdominal aortic aneurysm: the best documented screening
This is the only cardiovascular screening recommended by several authorities on the basis of randomised trials, in men who smoke or used to smoke, at a certain age. A single ultrasound suffices.
Both figures must nonetheless be quoted together. The number needed to screen to avoid 1 death from rupture is about 305. And the hazard ratio for all-cause mortality is 0.99, that is, not significant. Screening avoids deaths from aneurysm rupture, which is established, without it being possible to demonstrate that it extends life overall.
Cardiac screening in athletes: a debate still unresolved
| The source | The result | What is at stake |
|---|---|---|
| Systematic Italian programme with electrocardiogram, Veneto region | 89% fall in sudden death in athletes over 25 years | A before-and-after study, with no randomised control group |
| Cohort of screened young British footballers | 6 deaths out of 8 occurred in athletes whose screening was normal | A normal screen guarantees nothing |
| Position of the learned societies | Open disagreement between Europe and North America | Neither position rests on a randomised trial |
We will not settle a debate the learned societies themselves have not settled. We will quote the 2 sets of data.
How long people wait
In France, the median wait for a cardiologist appointment is 37 days. In England, cardiology follows the general 18-week target between referral and the start of treatment, met for only a share of patients. These 2 measures do not cover the same thing and do not compare.
What the studies do not allow us to state
We will not promise that a cardiac work-up prevents heart attacks, because the largest trial ever run did not reach significance. We will not claim that the calcium score makes people live longer, because no randomised trial has tested it. Nothing entitles us to write that measuring lipoprotein(a) opens the way to a targeted action, because no targeted treatment has demonstrated clinical benefit.
What we will say is that blood pressure, smoking, lipids, blood glucose and physical activity are the only levers whose effect is demonstrated by randomised trials. They are unspectacular and they are the best proven.
In practice, if this concerns you
You set out your problem, your symptoms or your question. Reports, test results and images already available can be reviewed before you arrive, so that the pathway can be prepared. The point is not to run every possible test, but to select those that can genuinely help confirm a hypothesis, rule out a risk or guide a decision. The results are brought together in a single summary and the next steps are organised. Follow-up is then coordinated.
Need medical advice quickly? For a worry that does not call for emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the work-up pathway.
Further reading
The companion articles.
What” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/what-a-health-assessment-can-actually-find/”>What a health assessment can actually find
How” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/how-we-build-a-health-assessment/”>How we build a health assessment
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