Published: 11/06/14

Company response

Life Line Screening said:

Cardiovascular disease (CVD) affects the lives of millions of people and is one of the largest causes of death and disability in this country. Stroke is one of the top three causes of death in England and is a leading cause of adult disability. Within the UK, over 150,000 strokes occur annually and over 300,000 people are living with moderate or severe disability due to stroke. Stroke costs about £7 billion a year. Most strokes are caused by occlusive arterial disease (obstruction in the vessels providing oxygen rich blood), around 15% are due to atrial fibrillation (AF) which is an irregular heart rhythm, and a further 15% or more are associated with carotid artery stenosis (CAS), narrowing of the vessels supplying blood to the brain. Many strokes could be avoided if people with AF and CAS were identified and treated appropriately with the relevant drugs as well as encouraging them to stop smoking. Some younger patients with tight carotid stenosis, who are well treated medically, can avoid future stroke by appropriate carotid intervention.

Carotid artery screening looks at the build-up of plaque in the arteries and blood flow to the brain. There are two large and well-known clinical trials carried out on asymptomatic population called ‘Asymptomatic Carotid Atherosclerosis Study’ (ACAS) and ‘Asymptomatic Carotid Surgery Trial’

(ACST). ACST which was performed in the UK, concluded that in asymptomatic patients younger than 75 years of age with carotid diameter reduction about 70% or more on ultrasound (many of whom were on aspirin, antihypertensive, and, in recent years, statin therapy), immediate Endarterectomy halved the net 5-year stroke risk. As the surgical intervention for asymptomatic people with significant Carotid stenosis is widely acceptable, ACST-2 is up and running in the UK which relates to the establishment of the best surgical intervention.

ACAS which was performed in the North America also showed the same result (aggregate risk reduction of 53%). This underlines the value of performing screening to identify the risk and if present, minimize them both medically and surgically if indicated. Recently, great advances in medical treatment of atherosclerotic disease, with aggressive risk factor modification have made surgical intervention less necessary.

Where surgery is deemed appropriate, this research indicates the benefits of this form of treatment relating to asymptomatic stroke risk in a 10 year study that compared randomized trial populations.

Additionally, it may be worth noting that advice is also given relating to ways to reduce your risks from stroke using medication and changes in lifestyle (some factsheets are also enclosed) – this is particularly relevant for those who have mild to moderate plaque build-up. For example, statins have been shown to reduce risks of Stroke, and a piece of research by the Heart Protection Study, as published in The Lancet outlines the evidence and success in achieving this. Please see the attached appendix for this particular piece of research.

Professor Andrew Nicolaides[i], concludes that ultrasound arterial scans can detect preclinical (silent) atherosclerotic plaques in asymptomatic individuals that may develop in the arteries slowly over several decades before they rupture or obstruct an artery becoming clinically manifest.

Ultrasound could prove a potent tool in lifestyle modification as there is nothing more powerful than asymptomatic individuals experiencing a real-time image of their arteries showing atherosclerotic deposits.

NICE also announced that Statin therapy is recommended as part of the management strategy for the primary prevention of cardiovascular diseases for adults who have a 20% or greater 10-year risk

of developing cardiovascular disease. Please see attached NICE clinical Guideline 67.

Life Line Screening packages of scans look at a wide range of risk factors for Stroke, including Peripheral Arterial Disease, Atrial Fibrillation, Hypertension and lifestyle -as well as the blood flow and plaque levels in your Carotid arteries. The results from all screenings, along with medical history, helps determine overall risks from cardiovascular disease and Stroke. It is telling that more than 12,500 strokes each year are directly related to Atrial Fibrillation (AF) - a condition that increases risks of stroke five-fold, a fact that most people are unaware of. At 40, we all have a one in four chance of developing AF.

And while we do offer screenings typically as packages because we believe the screenings work best together, people can choose to purchase only one if they desire.

The Ankle – Brachial Index has been shown helpful in identification of people without symptoms who are at increased risk of cardiovascular disease beyond their traditional risk factors as less than 50% of patients are symptomatic. The American Heart Association suggests that abnormal ABPI is a useful addition to the risk assessment of the disease in individuals at neither clearly high risk nor low risk of traditional risk factors. It may potentially increase the predictive value, sensitivity and specificity of risk classifications of the patients aged 50 or more.

Another Meta-analysis by Ankle Brachial Index Collaboration supports this idea by stating that cardiovascular mortality, total mortality and all major coronary events risk in Framingham risk stratification is almost doubled when abnormal ABPI is combined with the Framingham risk score.

Additionally, here is a link for more information relevant to the increased risk of clinical cardiovascular disease associated with having a low ABI.

http://www.ncbi.nlm.nih.gov/pubmed?term=heald%202006%20abi

The INVADE study supports preventive screening for vascular disease. This was an 8-year outcomes study of 11,000 patients which shows strong evidence of the health and financial benefits of preventive screening with follow-on primary care. (Journal American Heart Association, doi. 10.1161/JAHA.112.000786). In addition to finding disease early, other research has shown positive behavioral impacts to both weight loss and medication adherence following screenings. (Presented at the American College of Cardiology, 61st Annual Scientific Session).

Of course, certain medical conditions are not preventable (for example, various diseases that are caused by genetic factors). However, other medical conditions can be prevented. It is widely accepted that Stroke falls into the category of conditions that are largely related to modifiable risk factors rather than predominantly non-modifiable risk factors. This is why many leading organisations agree that 80% of strokes can be prevented.

Our services encompass a wide variety of risk factors. Customers who attend our screenings have

the opportunity to review their blood pressure, blood sugar, lipid profile, heart rhythm, and lifestyle factors such as exercise levels, tobacco use, diet and alcohol consumption all aimed at helping them reduce their risks and live healthier lives.

To give some appreciation of the impact of what happens when we find an abnormal result, you may be interested in this recent piece of TV footage, showing an example of the process when a Life Line Screening patient is referred to a hospital for follow-up treatment:

http://www.youtube.com/watch?v=h-Fpet6-qE0

In fact, research conducted in the United States affirms that fully 50% of all AAAs will not be even eligible for screening under current USA federal guidelines. This study, which was published in the Journal of Vascular Surgery, with a follow on paper in the Annals of Surgery, was hailed as a landmark paper when it was presented. Similar research, conducted in the UK by Dr. Mohsen Chabok in collaboration with Dr. Aslam of Imperial College London, had supportive findings and was presented at the XXV World Congress of the International Union of Angiology, 2012 in Prague. A further updated study on the prevalence of AAA in the UK and Ireland will be presented at the IUA World Congress in Sydney this August. Life Line Screening will additionally be presenting data at a symposium on “Screening for Cardiovascular Disease”. Our UK Clinical Director will be joined by Professor Nicolaides, Emeritus Professor of Vascular Surgery at Imperial College, London, who is a research collaborator helping us and greater healthcare community better understand the extend of vascular disease among population and observational epidemiology.

We are also supporting a prospective study conducted at Imperial College London titled “An observational study of the natural history of cardiovascular diseases”. The purpose of the study is to estimate the contemporary prevalence of cardiovascular diseases in the UK and to describe the incidence and prevalence of stroke, mini stroke (TIA), Heart Attack (MI), deaths and interventions repairs for carotids and occlusive arterial disease in a large population. This study will also allow us to obtain reliable information on the age and sex-specific relevance of tobacco and alcohol consumption, obesity, diabetes and blood pressure as risk factors for different cardiovascular diseases.

[1] Director of the Vascular Screening and Diagnostic Centre, Emeritus Professor of Vascular Surgery at Imperial College, London, Chairman of the Cardiovascular Disease Educational and Research Trust (CDERT) and Member of the Life Line Screening UK Expert Medical Board.

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Life Line Screening is involved in scientific research including such partners as Oxford University and Imperial College London with whom we are working to better understand the extent of vascular disease among various populations. We have an extensive international scientific network which can be viewed at www.lifelinescreeningresearch.com. Prof. Andrew Nicolaides, Director of the Vascular Screening and Diagnostic Centre at Imperial College London, concludes that ultrasound arterial scans can detect preclinical (silent) atherosclerotic plaques in asymptomatic individuals that may develop in the arteries slowly over several decades before they rupture or obstruct an artery becoming clinically manifest.