Association of Screenings for Hypertension, Diabetes, and High Cholesterol With All-Cause and Cardiovascular Mortality: Evidence From a Cohort Study

Abstract

Screenings for hypertension, diabetes, and high cholesterol are widely conducted in routine clinical practice for cardiovascular disease (CVD) prevention. However, few studies have investigated whether these screenings could eventually lead to lower risks of hard outcomes such as mortality. This cohort study aimed to examine directly the association of screenings for hypertension, diabetes, and high cholesterol with all-cause and cardiovascular mortality and whether the association, if existent, varied with important characteristics. A nationally representative sample of 86 587 US adults without the three conditions and CVD at baseline were recruited. The history of screenings for the three conditions was elicited by a series of questions in the surveys. All-cause and cardiovascular mortality were ascertained by linkage to National Death Index records through December 31, 2019. The association of screenings with mortality was investigated by multivariable Cox regression analysis and expressed as hazard ratio (HR) with 95% confidence interval (CI), adjusting for major risk factors of CVD and mortality. The “1 screening,” “2 screenings,” “3 screenings,” and “any screening” (combining the above three) groups were compared with the “no screening” group separately. During a median follow-up of 51 months (4.3 years), 1783 participants died and 366 of them were attributed to CVD. After adjusting for all covariates, no statistically significant association was found between “any screening” and all-cause mortality (HR = 1.08, 95% CI 0.92–1.26) or cardiovascular mortality (HR = 1.06, 95% CI 0.76–1.47). The results were consistent across various subgroups. The associations of “1 screening,” “2 screenings,” and “3 screenings” respectively with all-cause and cardiovascular mortality were not statistically significant either (HRs ranging from 0.65 to 1.40). Overall, in this population of US general adults, there was no evidence that screening for hypertension, diabetes, and high cholesterol could lead to lower all-cause or cardiovascular mortality.