No benefit from repeated cardiovascular screening among 72-year-old Danes: 5-year follow up in the Viborg Screening Program (VISP +5 )

No benefit from repeated cardiovascular screening among 72-year-old Danes: 5-year follow up in the Viborg Screening Program (VISP +5 ) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report No benefit from repeated cardiovascular screening among 72-year-old Danes: 5-year follow up in the Viborg Screening Program (VISP +5 ) Annette Høgh, Maiken Faklam, Bibi Damsgaard, Jes Lindholt, Marie Dahl This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7869517/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective To investigate benefits of five-year re-screening among individuals without previous screen-detected carotid plaque (CP), with primary focus on presence of CP. Secondary outcomes included lower extremity artery disease (LEAD), abdominal aortic aneurysm (AAA), hypertension (HT), and diabetes mellitus (DM). The Viborg Screening Program (VISP) offers combined cardiovascular screening to all 67-year-olds Danes living in Viborg Municipality, including CP assessment. The present observational cohort study (VISP + 5 ) was conducted from November 2020 to June 2021. The VISP + 5 cohort included VISP participants without ultrasound-verified CP at baseline, who were subsequently invited to undergo repeated screening at age 72. Results A total of 945 VISP participants had a five-year follow-up period (range: 4.50 to 5.49 years); 570 (60.3%) had no CP at baseline screening, 21 died, and 3 were lost to follow-up. 546 were eligible for VISP + 5 , of whom 458 attended (83.9%). Presence of CP was observed in 25 (5.5%), while LEAD in 4 (0.9%), AAA in 1 (0.2%), HT in 29 (6.3%) and DM in 8 (1.8%). No participant had more than one new screen-detected condition. The fact that only a small proportion developed CP, and even fewer developed other cardiovascular-related conditions, suggests minimal benefit from repeated cardiovascular screening within this timeframe. Cardiovascular screening Carotid plaque Repeated screening Rescreening Atherosclerotic plaque sex cardiovascular disease prevention Figures Figure 1 Introduction The optimal time window for population-based cardiovascular disease screening is yet undetermined and so is the benefit of repeated screening. Cardiovascular events are preventable, and screening is an important tool to identify asymptomatic individuals [ 1 ]. Traditional risk stratification tools such as the Framingham Risk Score or Systematic Coronary Risk Evaluation (SCORE2) often underestimate risk, particularly in asymptomatic individuals [ 2 , 3 ]. Further, the evidence on benefit of re-screening for subclinical atherosclerosis remains spares [ 4 ]. Viborg Screening Program (VISP) [ 5 ] addresses these shortcomings and provides a unique opportunity to evaluate the value of cardiovascular screening. All 67-year-old citizens of Viborg Municipality, Denmark, are offered screening for carotid plaque (CP), lower extremity artery disease (LEAD), abdominal aortic aneurysm (AAA), hypertension (HT), and diabetes mellitus (DM) [ 5 ]. While the initial VISP screening provides a baseline risk stratification, the benefit of repeated screening has not been evaluated. This sub-study, VISP + 5 , nested within VISP, conducted a repeated screening among participants five years after a CP-negative baseline screening (age 72). CP detectable via ultrasound is a reliable and user friendly marker of subclinical atherosclerosis. A comprehensive review from 2024 confirmed that ultrasound-detected CP is a strong predictor of future cardiovascular events [ 6 ]. Additionally, a Norwegian study demonstrated that CP detection outperformed the updated SCORE2 algorithm in predicting major adverse cardiovascular events[ 7 ]. Building on this evidence, the VISP + 5 study explored the potential benefit of repeated non-invasive ultrasound screening to improve stratification and early intervention. Objective The study aimed to investigate the potential benefits of re-screening in 72-years-old screening participants five years after a negative baseline screening in VISP. The primary objective was to assess the presence of CP. Secondary objectives included detection of newly developed LEAD, AAA, HT, and DM within the same cohort. Methods The VISP + 5 study is an observational cohort study nested within VISP - a population-based cardiovascular screening initiative. The VISP protocol, including eligibility criteria and screening procedures has been previously published [ 5 ]. Population and Recruitment VISP targets all citizens of Viborg Municipality upon turning 67 years, with screening of approximately 1,000 individuals annually. From the original VISP cohort, those screened in 2015-16 formed the basis for VISP + 5 follow-up. Between November 2020 to June 2021, 945 VISP participants reached a 5-year follow-up (IQR 4.50 to 5.49 years). Of these, 570 had no CP at baseline. Twenty-four were excluded (21 deceased, 3 data errors) leaving 546 invited for repeated screening at the Vascular department on Regional Hospital Viborg, Denmark. No further in- or exclusion criteria were applied. A participant flowchart is shown in Fig. 1 . Materials All screening procedures followed the original VISP protocol [ 5 ]. All assessments were conducted by the second author - a single trained operator certified by the VISP team, to minimize inter-observer variability. Screening included: Bilateral carotid ultrasound for CP (a focal structure into the arterial lumen ≥ 0.5 mm or ≥ 50% of the surrounding vessel), ankle-brachial index (ABI < 0.9 or ≥ 1.4) for LEAD, aortic diameter measurement via ultrasound for AAA (aorta ≥ 30 mm), blood pressure measurements in both arms for HT (≥ 160/100 mmHg), hemoglobin A1c (HbA1c ≥ 48 mmol/mol) testing for undiagnosed diabetes. Clinical measures were supplemented with lifestyle variables and medical histories, collected via structured questionnaire. Statistical Analysis Baseline characteristics of participants with and without newly screen-detected CP and results were reported by Person chi-square test. Data were managed using REDCap and analyzed with STATA 17.0 (StataCorp, TX, USA). Variables such as body mass index (BMI), alcohol use and HbA1c were categorized for analysis. Sex-specific stratification was performed. Results Participation and Demographics Of the 546 invited for repeated screening, 88 were non-responders leaving 458 citizens to be rescreened with an attendance-rate of 83.9% (Fig. 1 ). Despite equal number of men and women being invited, a significant gender disparity in attendance was observed, with 70% of the non-attendees being women, (p = 0.014). Table 1 presents self-reported baseline characteristics stratified by CP status and sex. No significant differences were observed between groups in lifestyle factors, comorbidities, or medication use, irrespective of subsequent CP development. Variables such as BMI ≥ 25 and physical activity showed no predictive value, and no association was found between smoking (p = 0.582) or BMI ≥ 25 (p = 0.377) and presence of CP. Table 1 Baseline characteristics (self-reported), stratified by carotid plaque (CP) status and sex (n = 458) Baseline characteristics All Absence Presence of CP of CP p-value Women Presence of CP Men p-value Sex 0.653 Women 258 (56.3) 245 (53.5) 13 (2.8) - - Men 200 (43.7) 188 (43.4) 12 (2.6) - - BMI groups ( 1 missing) 0.371 0.369 30 101 (22.1) 96 (21.0) 5 (1.1) 2 (0.4) 3 (0.7) Smoking 0.841 0.788 Never 226 (49.4) 215 (49.6) 11 (2.4) 5 (1.1) 6 (1.3) Former 187 (40.8) 176 (38.4) 11 (2.4) 6 (1.3) 5 (1.1) Current 45 (9.8) 42 (9.2) 3 (0.7) 2 (0.4) 1 (0.2) Alcohol (units pr. week) 0.349 0.212 ♂< 14 / ♀ 21 / ♀>14 35 (7.6) 32 (7.0) 3 (0.7) 1 (0.2) 2 (0.4) Physical activity 0.582 0.433 Inactive 37 (8.1) 36 (7.8) 1 (0.2) 0 1 (0.2) Mild exercise 4 hours/week 304 (66.4) 289 (63.1) 15 (3.3) 9 (2.0) 6 (1.3) Medium hard exercise 4 hours/week 116 (25.3) 107 (23.4) 9 (2.0) 4 (0.9) 5 (1.1) Hard exercise 4 hours/week 1 (0.2) 1 (0.2) 0 0 0 Comorbidity Hypertension (1 missing) 213 (46.5) 200 (43.7) 13 (2.8) 0.578 5 (1.1) 8 (1.1) 0.158 Myocardial infarction 17 (3.7) 17 (3.7) 0 0.313 0 0 - Angina pectoris (2 missing) 27 (5.9) 26 (5.7) 1 (0.2) 0.676 1 0.27) 0 0.327 Atrial fibrillation 54 (11.8) 49 (10.7) 5 (1.1) 0.191 3 (0.7) 2 (0.4) 0.689 Stroke 22 (4.8) 20 (4.4) 2 (0.4) 0.442 2 (0.4) 0 0.157 Lower extremity artery disease 11 (2.4) 11 (2.4) 0 0.420 0 0 - Abdominal aorta aneurysm ( 1 missing) 3 (0.7) 3 (0.7) 0 0.676 0 0 - Diabetes 43 (9.4) 40 (8.7) 3 (0.7) 0.645 1 (0.2) 2 (0.2) 0.490 Medicine Lipid lowering 142 (31.0) 135 (29.4) 7 (1.5) 0.738 3 (0.7) 4 (0.9) 0.568 Antiplatelet 78 (17.0) 74 (16.2) 4 (0.9) 0.888 2 (0.4) 2 (0.4) 0.930 Anticoagulants 43 (9.4) 40 (8.7) 3 (0.7) 0.645 1 (0.2) 2 (0.4) 0.490 Antihypertensives 220 (48.0) 205 (44.8) 15 (3.2) 0.218 7 (1.5) 8 (1.7) 0.513 Thiazide 51 (11.1) 48 (10.5) 3 (0.7) 0.888 1 (0.2) 2 (0.4) 0.490 ACE inhibitor 52 (11.4) 46 (10.0) 6 (1.3) 0.040 3 (0.7) 3 (0.7) 0.910 Ang II antagonist 91 (19.9) 89 (19.4) 2 (0.4) 0.126 0 2 (0.4) 0.125 Calcium antagonist 74 (16.2) 67 (14.6) 7 (1.5) 0.098 2 (0.4) 5 (1.1) 0.144 Beta antagonist 66 (14.4) 61 (13.3) 5 (1.1) 0.413 3 (0.7) 2 (0.4) 0.689 Antidiabetics 39 (8.5) 36 (8.3) 3 (0.7) 0.521 1 (0.2) 2 (0.4) 0.490 BMI: Body mass index, ACE: Angiotensin Converting Enzyme, Ang II antagonist: Angiotensin II antagonist. Comorbidity is categorized no/current + earlier events Development of Carotid Plaque Over Five Years Among the 458 participants, 25 (5.5%; 95% CI: 3.7–7.9%) had developed CP in one or more vascular territories. CP was most frequently detected in the carotid bulb (72%) (Table 2 ). Table 2 Screening results, including CP location (n = 458) All Women Men p-value Screening results n (%) 458 258 (56.3) 200 (43.7) Presence of carotid plaque and location 25* 13 (2.8) 12 (2.6) 0.653 Common carotid artery 3 2 (0.4) 1 (0.2) 0.588 Bulb segment of common carotid artery 18 9 (2.0) 9 (2.0) 0.748 Internal carotid plaque 6 3 (0.7) 3 (0.7) 0.910 External carotid plaque 1 1 (0.2) 0 0.327 Lower extremity artery disease < 0.9 and/or ≥ 1.4 5 (1.1) 2 (0.5) 3 (0.7) 0.459 Aorta (mm) 0.274 30 1 (0.2) 0 1 (0.2) Blood pressure ≥160/100 mmHg 79 (17.3) 43 (9.4) 36 (7.9) 0.708 Systolic interarm differences (≥ 10mmHg) (9 missing) 96 (21.1) 55 (12.0) 41 (8.9) 0.404 HbA1c (mmol/mol) 0.609 48 36 (7.9) 19 (4.1) 17 (3.7) Waistline (cm) < 0.001 ♂ < 94 / ♀ 102 / ♀ >88 214 (46.8) 149 (32.5) 65 (14.2) * Total exceeds 25 due to multiple plaques in some participants. Five-Year Development of LEAD, AAA, HT, DM and Self-Reported Medication Use At follow-up, a total of 67 participants (14.6%) were identified with at least one new cardiovascular or metabolic finding (Table 2 ). LEAD was detected in four participants (0.9%), of whom one had a known diagnosis. One new case of AA was identified (0.2%), and two participants with previously detected aortic ectasia were reclassified as stable findings. Despite self-reporting no history of HT, 29 participants (6.3%) presented with elevated blood pressure (≥ 160/100 mmHg). Among 36 participants with HbA1c ≥ 48 mmol/mol, eight (1.8%) had no prior diagnosis of DM. No participant was diagnosed with more than one new condition. Among the 25 participants with incident CP, seven reported ongoing antithrombotic therapy before re-screening, and 15 initiated treatment after re-screening. Regarding lipid-lowering therapy, seven participants reported current use, and 16 were newly initiated (Table 1 ). Overall, new vascular findings were infrequent, with hypertension being the most common newly detected abnormality at follow-up. Discussion This study demonstrates that a large majority (94.5%) of 72-years-old VISP + 5 participants remained free of screen-detected CP five years after a CP-free baseline screening. Only a small proportion (5.5%) developed CP, and even fewer developed other cardiovascular related conditions, suggesting minimal benefit from repeated cardiovascular screening within this timeframe. The low incidence of CP among the previously CP-free participants is striking, especially compared to baseline VISP findings, where CP was detected in 44.8% of men and 31.8% of women [ 8 ]. This suggests that individuals without ultrasound-detectable CP at age 67 have a very low probability of developing CP over the next five years. Similar trends were seen for LEAD [ 8 ]. The low incidence of both CP and LEAD over a five-year period supports slow, age-related progression of atherosclerosis in this subgroup. It indicates an association between CP and LEAD, supporting the notion that significant atherosclerotic progression is isolated, infrequent and merely present at age 72 if not present at age 67. This aligns with the systemic nature of atherosclerosis, where the absence of early signs across vascular territories likely reflects low long-term risk [ 9 ]. The optimal time window for population-based cardiovascular screening is yet undetermined and so is the benefit of repeated screening [ 4 ]. Accordingly, our results imply that routine repeated screening for cardiovascular disease within five years provides limited clinical value in individuals without previous screen-detected atherosclerosis. Despite being CP-free at the baseline screening, participants demonstrated high engagement with the follow-up screening, with an attendance rate of 83.9%, comparable to the original VISP rate of 83.4% [ 8 ]. Thus, VISP + 5 exceeds the commonly cited 70% threshold considered necessary for effective population-based cardiovascular screening programs, and for reducing health inequalities [ 10 ]. The high participation rate combined with low proportion of missing data enhances the representativeness of findings and support generalizability of results to the broader Danish population representing the same age group. Another strength of this study is also the methodological consistency ensured by having the same operator conduct all VISP + 5 examinations for all 458 participants. This operator was trained by the VISP screening team, and by the study´s senior staff (last author), who also trained the screening team. This training linage significantly minimized inter-operator variability and reduced inter-participant discrepancies [ 11 ]. Additionally, the same model of ultrasound-scanner was used for both the original VISP and VISP + 5 eliminating the risk of technical differences in equipment performance to influence the detection of CP. In conclusion, VISP + 5 assessed the incidence of screen-detected atherosclerotic diseases among 72-years old Danes who had no detectable CP at the initial VISP screening at age 67. The study´s high attendance rate and methodological rigor lend credibility to its findings, which indicate low incidence of newly detected CP (5.5%). Likewise, the low incidence of both LEAD and AAA indicates that manifestations of atherosclerosis does not appear at age 72 if not present at age 67. These findings suggest that age 67 could represent an appropriate time window for a once-in-a-lifetime population-based cardiovascular disease screening, as extending the program with a second screening five years later appears to offer limited additional benefit. Limitations Although all eligible participants were invited to VISP + 5 , the overall cohort size remains relatively small. This limits the statistical power to analyze subgroups and constrains the ability to draw robust conclusions about the prevalence of specific cardiovascular disease findings. The cohort was not stratified according to carotid plaque characteristics, such as morphology, volume, or the total sum of plaque points across all segments, which aligns with the original VISP protocol [ 5 ], but it might have been beneficial to have recorded the degree of plaque following the latest plaque-reporting and Data system (RADS-classification system) [ 12 ]. Also, a five-year interval was chosen, but shorter or longer intervals may yield different results. Future work should explore plaque-category and alternative timing models or risk-adapted intervals and should contain 3D imaging with automation as it has shown to improve measurement agreement [ 13 ]. Abbreviations AAA = Abdominal Aortic Aneurysm ABI = Ankle-Brachial index BMI = Body mass index CP = Carotid Plaque DM = Diabetes Mellitus HbA1c = Hemoglobin A1c HT = Hypertension LEAD = lower extremity artery disease VISP = Viborg Inter-Sectorial Screening Programme VISP +5 = Viborg Inter-Sectorial Screening Programme, five-year follow up Declarations Ethics Approval and Consent to Participate The Viborg Screening Program (VISP) is a preventive public health initiative by Viborg Municipality, Denmark. Therefore, ethical approval from the Central Denmark Region Committees on Health Research Ethics (registration no. 1-10-72-163-19) was not required; only approval from the Danish Data Protection Agency was obtained (ID: 1-16-02-232-15). The sub-study VISP+5 was separately approved by the Central Denmark Region Committees on Health Research Ethics (registration no. 1-16-02-600-20) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to screening. Availability of data The data supporting the findings of this study are stored in the VISP REDCap database hosted at the University of Southern Denmark, Odense. Restrictions apply to the availability of these data, which were used under license for the present study and are therefore not publicly available. Data may, however, be made available from the first author upon reasonable request and with permission from the VISP Steering Committee. Consent for publication Not applicable, as no individual person’s data, images, or other identifying information are included in this manuscript. Funding The primary screening program (VISP) was funded by Viborg Municipality. The scientific work, including the VISP+5 study, was supported by the Department of Vascular Research. References Khambhati, J., et al., The art of cardiovascular risk assessment. Clin Cardiol, 2018. 41 (5): p. 677-684. Sofogianni, A., et al., Cardiovascular Risk Prediction Models and Scores in the Era of Personalized Medicine. J Pers Med, 2022. 12 (7). Voorbrood, V.M.I., et al., Underestimation of Cardiovascular Risk by the SCORE2 Model in Primary Care: A Call for Recalibration. Eur J Prev Cardiol, 2025. Gasperoni, F., et al., Optimal risk-assessment scheduling for primary prevention of cardiovascular disease. J R Stat Soc Ser A Stat Soc, 2025. 188 (3): p. 920-934. Høgh, A., et al., Protocol for a cohort study to evaluate the effectiveness and cost-effectiveness of general population screening for cardiovascular disease: the Viborg Screening Programme (VISP). BMJ Open, 2023. 13 (2): p. e063335. Garg, P.K., et al., Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies. Arterioscler Thromb Vasc Biol, 2024. 44 (1): p. 24-47. Ihle-Hansen, H., et al., Carotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population. J Am Heart Assoc, 2023. 12 (17): p. e030739. Dahl, M., et al., Relevance of the Viborg Population Based Screening Programme (VISP) for Cardiovascular Conditions Among 67 Year Olds: Attendance Rate, Prevalence, and Proportion of Initiated Cardiovascular Medicines Stratified By Sex. Eur J Vasc Endovasc Surg, 2023. 66 (1): p. 119-129. Högberg, D., et al., Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study. Eur J Vasc Endovasc Surg, 2019. 57 (6): p. 759-766. Lindholt, J.S. and R. Søgaard, Why and when to screen for cardiovascular disease in healthy individuals. Heart, 2021. 107 (12): p. 1010-1017. Mukabagorora, T., et al., A comprehensive scoping review of existing carotid duplex ultrasound scanning and reporting protocols: identifying gaps and opportunities for standardization of practice in low-income countries. J Ultrasound, 2025. Saba, L., et al., Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging, 2024. 17 (1): p. 62-75. Chan, C.W., et al., Inter-observer and intra-observer reliability between manual segmentation and semi-automated segmentation for carotid vessel wall volume measurements on three-dimensional ultrasonography. Ultrasonography, 2023. 42 (2): p. 214-226. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Dec, 2025 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviewers invited by journal 06 Nov, 2025 Editor assigned by journal 06 Nov, 2025 Editor invited by journal 23 Oct, 2025 Submission checks completed at journal 22 Oct, 2025 First submitted to journal 22 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":155642,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eParticipant flowchart\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7869517/v1/eb6a8ef4c3852c915d75f553.png"},{"id":96255954,"identity":"d785db52-0c1a-4f6b-80b0-b005e80c3b7d","added_by":"auto","created_at":"2025-11-19 07:49:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1065154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7869517/v1/27f62ca9-bf59-4ddb-8ea1-5926bc62efae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNo benefit from repeated cardiovascular screening among 72-year-old Danes: 5-year follow up in the Viborg Screening Program (VISP\u003csup\u003e +5\u003c/sup\u003e )\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe optimal time window for population-based cardiovascular disease screening is yet undetermined and so is the benefit of repeated screening. Cardiovascular events are preventable, and screening is an important tool to identify asymptomatic individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Traditional risk stratification tools such as the Framingham Risk Score or Systematic Coronary Risk Evaluation (SCORE2) often underestimate risk, particularly in asymptomatic individuals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Further, the evidence on benefit of re-screening for subclinical atherosclerosis remains spares [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eViborg Screening Program (VISP) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] addresses these shortcomings and provides a unique opportunity to evaluate the value of cardiovascular screening. All 67-year-old citizens of Viborg Municipality, Denmark, are offered screening for carotid plaque (CP), lower extremity artery disease (LEAD), abdominal aortic aneurysm (AAA), hypertension (HT), and diabetes mellitus (DM) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While the initial VISP screening provides a baseline risk stratification, the benefit of repeated screening has not been evaluated.\u003c/p\u003e\u003cp\u003eThis sub-study, VISP\u003csup\u003e+ 5\u003c/sup\u003e, nested within VISP, conducted a repeated screening among participants five years after a CP-negative baseline screening (age 72). CP detectable via ultrasound is a reliable and user friendly marker of subclinical atherosclerosis. A comprehensive review from 2024 confirmed that ultrasound-detected CP is a strong predictor of future cardiovascular events [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, a Norwegian study demonstrated that CP detection outperformed the updated SCORE2 algorithm in predicting major adverse cardiovascular events[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Building on this evidence, the VISP\u003csup\u003e+ 5\u003c/sup\u003e study explored the potential benefit of repeated non-invasive ultrasound screening to improve stratification and early intervention.\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eThe study aimed to investigate the potential benefits of re-screening in 72-years-old screening participants five years after a negative baseline screening in VISP. The primary objective was to assess the presence of CP. Secondary objectives included detection of newly developed LEAD, AAA, HT, and DM within the same cohort.\u003c/p\u003e\n\n"},{"header":"Methods","content":"\u003cp\u003eThe VISP\u003csup\u003e+ 5\u003c/sup\u003e study is an observational cohort study nested within VISP - a population-based cardiovascular screening initiative. The VISP protocol, including eligibility criteria and screening procedures has been previously published [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003ePopulation and Recruitment\u003c/h3\u003e\u003cp\u003eVISP targets all citizens of Viborg Municipality upon turning 67 years, with screening of approximately 1,000 individuals annually. From the original VISP cohort, those screened in 2015-16 formed the basis for VISP\u003csup\u003e+ 5\u003c/sup\u003e follow-up. Between November 2020 to June 2021, 945 VISP participants reached a 5-year follow-up (IQR 4.50 to 5.49 years). Of these, 570 had no CP at baseline. Twenty-four were excluded (21 deceased, 3 data errors) leaving 546 invited for repeated screening at the Vascular department on Regional Hospital Viborg, Denmark. No further in- or exclusion criteria were applied. A participant flowchart is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eMaterials\u003c/h3\u003e\n\u003cp\u003eAll screening procedures followed the original VISP protocol [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. All assessments were conducted by the second author - a single trained operator certified by the VISP team, to minimize inter-observer variability. Screening included: Bilateral carotid ultrasound for CP (a focal structure into the arterial lumen\u0026thinsp;\u0026ge;\u0026thinsp;0.5 mm or \u0026ge;\u0026thinsp;50% of the surrounding vessel), ankle-brachial index (ABI\u0026thinsp;\u0026lt;\u0026thinsp;0.9 or \u0026ge;\u0026thinsp;1.4) for LEAD, aortic diameter measurement via ultrasound for AAA (aorta\u0026thinsp;\u0026ge;\u0026thinsp;30 mm), blood pressure measurements in both arms for HT (\u0026ge;\u0026thinsp;160/100 mmHg), hemoglobin A1c (HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;48 mmol/mol) testing for undiagnosed diabetes. Clinical measures were supplemented with lifestyle variables and medical histories, collected via structured questionnaire.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eBaseline characteristics of participants with and without newly screen-detected CP and results were reported by Person chi-square test. Data were managed using REDCap and analyzed with STATA 17.0 (StataCorp, TX, USA). Variables such as body mass index (BMI), alcohol use and HbA1c were categorized for analysis. Sex-specific stratification was performed.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eParticipation and Demographics\u003c/h2\u003e\u003cp\u003eOf the 546 invited for repeated screening, 88 were non-responders leaving 458 citizens to be rescreened with an attendance-rate of 83.9% (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Despite equal number of men and women being invited, a significant gender disparity in attendance was observed, with 70% of the non-attendees being women, (p\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.014).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents self-reported baseline characteristics stratified by CP status and sex. No significant differences were observed between groups in lifestyle factors, comorbidities, or medication use, irrespective of subsequent CP development. Variables such as BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 and physical activity showed no predictive value, and no association was found between smoking (p\u0026thinsp;=\u0026thinsp;0.582) or BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 (p\u0026thinsp;=\u0026thinsp;0.377) and presence of CP.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eBaseline characteristics (self-reported), stratified by\u003c/em\u003e carotid plaque (CP) \u003cem\u003estatus and sex (n\u0026thinsp;=\u0026thinsp;458)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eAbsence Presence\u003c/p\u003e\u003cp\u003eof CP of CP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePresence of CP\u003c/p\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.653\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200 (43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e188 (43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI groups (\u003c/b\u003e1 missing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd 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colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.841\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.788\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e226 (49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e215 (49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187 (40.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176 (38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol (units pr. week)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.349\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.212\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂\u0026lt; 14 / ♀ \u0026lt; 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e343 (74.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e323 (70.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂14\u0026ndash;21 / ♀7\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80 (17.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂\u0026gt;21 / ♀\u0026gt;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.582\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.433\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInactive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild exercise 4 hours/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e304 (66.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e289 (63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium hard exercise 4 hours/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHard exercise 4 hours/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension (1 missing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e213 (46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e200 (43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.578\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.158\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMyocardial infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.313\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngina pectoris (2 missing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.676\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.327\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.191\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.689\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.442\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.157\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower extremity artery disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.420\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal aorta aneurysm\u003c/p\u003e\u003cp\u003e\u003cb\u003e(\u003c/b\u003e1 missing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.676\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.645\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.490\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedicine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLipid lowering\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e142 (31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135 (29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.738\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.568\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiplatelet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.888\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.930\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnticoagulants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.645\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.490\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e220 (48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e205 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.218\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.513\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eThiazide\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.888\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.490\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eACE inhibitor\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.040\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.910\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAng II antagonist\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e91 (19.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.126\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.125\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCalcium antagonist\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.098\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.144\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBeta antagonist\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.413\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.689\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntidiabetics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.521\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e0.490\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eBMI: Body mass index, ACE: Angiotensin Converting Enzyme, Ang II antagonist: Angiotensin II antagonist. Comorbidity is categorized no/current\u0026thinsp;+\u0026thinsp;earlier events\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDevelopment of Carotid Plaque Over Five Years\u003c/h3\u003e\n\u003cp\u003eAmong the 458 participants, 25 (5.5%; 95% CI: 3.7\u0026ndash;7.9%) had developed CP in one or more vascular territories. CP was most frequently detected in the carotid bulb (72%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScreening results, including CP location (n\u0026thinsp;=\u0026thinsp;458)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScreening results n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e258 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e200 (43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of carotid plaque and location\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.653\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommon carotid artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.588\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBulb segment of common carotid artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.748\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal carotid plaque\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.910\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExternal carotid plaque\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.327\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLower extremity artery disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 0.9 and/or \u0026ge;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.459\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAorta (mm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.274\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e456 (99.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e258 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e198 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood pressure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;160/100 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.708\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystolic interarm differences (\u0026ge;\u0026thinsp;10mmHg)\u003c/p\u003e\u003cp\u003e(9 missing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.404\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHbA1c (mmol/mol)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.609\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e382 (83.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e219 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e163 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e42\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWaistline (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂ \u0026lt; 94 / ♀ \u0026lt; 80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69 (15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂ 94\u0026ndash;102 / ♀ 80\u0026ndash;88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e♂ \u0026gt;102 / ♀ \u0026gt;88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e214 (46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e149 (32.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e* Total exceeds 25 due to multiple plaques in some participants.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eFive-Year Development of LEAD, AAA, HT, DM and Self-Reported Medication Use\u003c/h3\u003e\n\u003cp\u003eAt follow-up, a total of 67 participants (14.6%) were identified with at least one new cardiovascular or metabolic finding (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). LEAD was detected in four participants (0.9%), of whom one had a known diagnosis. One new case of AA was identified (0.2%), and two participants with previously detected aortic ectasia were reclassified as stable findings. Despite self-reporting no history of HT, 29 participants (6.3%) presented with elevated blood pressure (\u0026ge;\u0026thinsp;160/100 mmHg). Among 36 participants with HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;48 mmol/mol, eight (1.8%) had no prior diagnosis of DM. No participant was diagnosed with more than one new condition.\u003c/p\u003e\u003cp\u003eAmong the 25 participants with incident CP, seven reported ongoing antithrombotic therapy before re-screening, and 15 initiated treatment after re-screening. Regarding lipid-lowering therapy, seven participants reported current use, and 16 were newly initiated (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, new vascular findings were infrequent, with hypertension being the most common newly detected abnormality at follow-up.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that a large majority (94.5%) of 72-years-old VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e participants remained free of screen-detected CP five years after a CP-free baseline screening. Only a small proportion (5.5%) developed CP, and even fewer developed other cardiovascular related conditions, suggesting minimal benefit from repeated cardiovascular screening within this timeframe.\u003c/p\u003e\u003cp\u003eThe low incidence of CP among the previously CP-free participants is striking, especially compared to baseline VISP findings, where CP was detected in 44.8% of men and 31.8% of women [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This suggests that individuals without ultrasound-detectable CP at age 67 have a very low probability of developing CP over the next five years. Similar trends were seen for LEAD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The low incidence of both CP and LEAD over a five-year period supports slow, age-related progression of atherosclerosis in this subgroup. It indicates an association between CP and LEAD, supporting the notion that significant atherosclerotic progression is isolated, infrequent and merely present at age 72 if not present at age 67. This aligns with the systemic nature of atherosclerosis, where the absence of early signs across vascular territories likely reflects low long-term risk [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe optimal time window for population-based cardiovascular screening is yet undetermined and so is the benefit of repeated screening [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Accordingly, our results imply that routine repeated screening for cardiovascular disease within five years provides limited clinical value in individuals without previous screen-detected atherosclerosis.\u003c/p\u003e\u003cp\u003eDespite being CP-free at the baseline screening, participants demonstrated high engagement with the follow-up screening, with an attendance rate of 83.9%, comparable to the original VISP rate of 83.4% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Thus, VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e exceeds the commonly cited 70% threshold considered necessary for effective population-based cardiovascular screening programs, and for reducing health inequalities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The high participation rate combined with low proportion of missing data enhances the representativeness of findings and support generalizability of results to the broader Danish population representing the same age group. Another strength of this study is also the methodological consistency ensured by having the same operator conduct all VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e examinations for all 458 participants. This operator was trained by the VISP screening team, and by the study\u0026acute;s senior staff (last author), who also trained the screening team. This training linage significantly minimized inter-operator variability and reduced inter-participant discrepancies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, the same model of ultrasound-scanner was used for both the original VISP and VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e eliminating the risk of technical differences in equipment performance to influence the detection of CP.\u003c/p\u003e\u003cp\u003eIn conclusion, VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e assessed the incidence of screen-detected atherosclerotic diseases among 72-years old Danes who had no detectable CP at the initial VISP screening at age 67. The study\u0026acute;s high attendance rate and methodological rigor lend credibility to its findings, which indicate low incidence of newly detected CP (5.5%). Likewise, the low incidence of both LEAD and AAA indicates that manifestations of atherosclerosis does not appear at age 72 if not present at age 67. These findings suggest that age 67 could represent an appropriate time window for a once-in-a-lifetime population-based cardiovascular disease screening, as extending the program with a second screening five years later appears to offer limited additional benefit.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eAlthough all eligible participants were invited to VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e, the overall cohort size remains relatively small. This limits the statistical power to analyze subgroups and constrains the ability to draw robust conclusions about the prevalence of specific cardiovascular disease findings. The cohort was not stratified according to carotid plaque characteristics, such as morphology, volume, or the total sum of plaque points across all segments, which aligns with the original VISP protocol [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], but it might have been beneficial to have recorded the degree of plaque following the latest plaque-reporting and Data system (RADS-classification system) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Also, a five-year interval was chosen, but shorter or longer intervals may yield different results. Future work should explore plaque-category and alternative timing models or risk-adapted intervals and should contain 3D imaging with automation as it has shown to improve measurement agreement [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAA = Abdominal Aortic Aneurysm\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eABI = Ankle-Brachial index\u003c/p\u003e\n\u003cp\u003eBMI = Body mass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCP = Carotid Plaque\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDM = Diabetes Mellitus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHbA1c = Hemoglobin A1c\u003c/p\u003e\n\u003cp\u003eHT = Hypertension\u003c/p\u003e\n\u003cp\u003eLEAD = lower extremity artery disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVISP = Viborg Inter-Sectorial Screening Programme\u003c/p\u003e\n\u003cp\u003eVISP\u003csup\u003e+5\u003c/sup\u003e= Viborg Inter-Sectorial Screening Programme, five-year follow up\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Viborg Screening Program (VISP) is a preventive public health initiative by Viborg Municipality, Denmark. Therefore, ethical approval from the Central Denmark Region Committees on Health Research Ethics (registration no. 1-10-72-163-19) was not required; only approval from the Danish Data Protection Agency was obtained (ID: 1-16-02-232-15).\u003c/p\u003e\n\u003cp\u003eThe sub-study VISP+5 was separately approved by the Central Denmark Region Committees on Health Research Ethics (registration no. 1-16-02-600-20) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to screening.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are stored in the VISP REDCap database hosted at the University of Southern Denmark, Odense. Restrictions apply to the availability of these data, which were used under license for the present study and are therefore not publicly available. Data may, however, be made available from the first author upon reasonable request and with permission from the VISP Steering Committee.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable, as no individual person\u0026rsquo;s data, images, or other identifying information are included in this manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary screening program (VISP) was funded by Viborg Municipality. The scientific work, including the VISP+5 study, was supported by the Department of Vascular Research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKhambhati, J., et al., \u003cem\u003eThe art of cardiovascular risk assessment.\u003c/em\u003e Clin Cardiol, 2018. \u003cstrong\u003e41\u003c/strong\u003e(5): p. 677-684.\u003c/li\u003e\n\u003cli\u003eSofogianni, A., et al., \u003cem\u003eCardiovascular Risk Prediction Models and Scores in the Era of Personalized Medicine.\u003c/em\u003e J Pers Med, 2022. \u003cstrong\u003e12\u003c/strong\u003e(7).\u003c/li\u003e\n\u003cli\u003eVoorbrood, V.M.I., et al., \u003cem\u003eUnderestimation of Cardiovascular Risk by the SCORE2 Model in Primary Care: A Call for Recalibration.\u003c/em\u003e Eur J Prev Cardiol, 2025.\u003c/li\u003e\n\u003cli\u003eGasperoni, F., et al., \u003cem\u003eOptimal risk-assessment scheduling for primary prevention of cardiovascular disease.\u003c/em\u003e J R Stat Soc Ser A Stat Soc, 2025. \u003cstrong\u003e188\u003c/strong\u003e(3): p. 920-934.\u003c/li\u003e\n\u003cli\u003eH\u0026oslash;gh, A., et al., \u003cem\u003eProtocol for a cohort study to evaluate the effectiveness and cost-effectiveness of general population screening for cardiovascular disease: the Viborg Screening Programme (VISP).\u003c/em\u003e BMJ Open, 2023. \u003cstrong\u003e13\u003c/strong\u003e(2): p. e063335.\u003c/li\u003e\n\u003cli\u003eGarg, P.K., et al., \u003cem\u003eAssessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies.\u003c/em\u003e Arterioscler Thromb Vasc Biol, 2024. \u003cstrong\u003e44\u003c/strong\u003e(1): p. 24-47.\u003c/li\u003e\n\u003cli\u003eIhle-Hansen, H., et al., \u003cem\u003eCarotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population.\u003c/em\u003e J Am Heart Assoc, 2023. \u003cstrong\u003e12\u003c/strong\u003e(17): p. e030739.\u003c/li\u003e\n\u003cli\u003eDahl, M., et al., \u003cem\u003eRelevance of the Viborg Population Based Screening Programme (VISP) for Cardiovascular Conditions Among 67 Year Olds: Attendance Rate, Prevalence, and Proportion of Initiated Cardiovascular Medicines Stratified By Sex.\u003c/em\u003e Eur J Vasc Endovasc Surg, 2023. \u003cstrong\u003e66\u003c/strong\u003e(1): p. 119-129.\u003c/li\u003e\n\u003cli\u003eH\u0026ouml;gberg, D., et al., \u003cem\u003eFive Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study.\u003c/em\u003e Eur J Vasc Endovasc Surg, 2019. \u003cstrong\u003e57\u003c/strong\u003e(6): p. 759-766.\u003c/li\u003e\n\u003cli\u003eLindholt, J.S. and R. S\u0026oslash;gaard, \u003cem\u003eWhy and when to screen for cardiovascular disease in healthy individuals.\u003c/em\u003e Heart, 2021. \u003cstrong\u003e107\u003c/strong\u003e(12): p. 1010-1017.\u003c/li\u003e\n\u003cli\u003eMukabagorora, T., et al., \u003cem\u003eA comprehensive scoping review of existing carotid duplex ultrasound scanning and reporting protocols: identifying gaps and opportunities for standardization of practice in low-income countries.\u003c/em\u003e J Ultrasound, 2025.\u003c/li\u003e\n\u003cli\u003eSaba, L., et al., \u003cem\u003eCarotid Plaque-RADS: A Novel Stroke Risk Classification System.\u003c/em\u003e JACC Cardiovasc Imaging, 2024. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 62-75.\u003c/li\u003e\n\u003cli\u003eChan, C.W., et al., \u003cem\u003eInter-observer and intra-observer reliability between manual segmentation and semi-automated segmentation for carotid vessel wall volume measurements on three-dimensional ultrasonography.\u003c/em\u003e Ultrasonography, 2023. \u003cstrong\u003e42\u003c/strong\u003e(2): p. 214-226.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiovascular screening, Carotid plaque, Repeated screening, Rescreening, Atherosclerotic plaque, sex, cardiovascular disease prevention","lastPublishedDoi":"10.21203/rs.3.rs-7869517/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7869517/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo investigate benefits of five-year re-screening among individuals without previous screen-detected carotid plaque (CP), with primary focus on presence of CP. Secondary outcomes included lower extremity artery disease (LEAD), abdominal aortic aneurysm (AAA), hypertension (HT), and diabetes mellitus (DM). The Viborg Screening Program (VISP) offers combined cardiovascular screening to all 67-year-olds Danes living in Viborg Municipality, including CP assessment. The present observational cohort study (VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e) was conducted from November 2020 to June 2021. The VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e cohort included VISP participants without ultrasound-verified CP at baseline, who were subsequently invited to undergo repeated screening at age 72.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 945 VISP participants had a five-year follow-up period (range: 4.50 to 5.49 years); 570 (60.3%) had no CP at baseline screening, 21 died, and 3 were lost to follow-up. 546 were eligible for VISP\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e, of whom 458 attended (83.9%). Presence of CP was observed in 25 (5.5%), while LEAD in 4 (0.9%), AAA in 1 (0.2%), HT in 29 (6.3%) and DM in 8 (1.8%). No participant had more than one new screen-detected condition. The fact that only a small proportion developed CP, and even fewer developed other cardiovascular-related conditions, suggests minimal benefit from repeated cardiovascular screening within this timeframe.\u003c/p\u003e","manuscriptTitle":"No benefit from repeated cardiovascular screening among 72-year-old Danes: 5-year follow up in the Viborg Screening Program (VISP +5 )","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 08:39:27","doi":"10.21203/rs.3.rs-7869517/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-18T12:55:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T21:51:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263552823243889779634599548711368052080","date":"2025-11-11T13:47:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-06T10:16:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T09:44:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-23T09:04:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-22T14:56:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-10-22T13:39:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5cfcb54-2555-4f12-a03f-db3a4da2e9da","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T13:53:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 08:39:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7869517","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7869517","identity":"rs-7869517","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}