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Study Gives Big Boost To Coronary Calcium CT

December 24, 2013
Written by: , Filed in: Cardiac Imaging
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A study published Monday could radically change who gets CT screening for coronary artery calcium.

Such screening is not now recommended for people considered at low risk. But the study found that not only could the screening identify some supposedly low risk subjects who were actually at high risk, but it could also find the opposite: a surprisingly large number of people considered at high risk who in reality could scale back aggressive, long-term therapies.

Lead author Michael G. Silverman, MD, summed it up this way:

We showed that by using only the traditional risk factors, we miss a significant percentage of individuals at high risk. We may also be overtreating a large number of people who can safely avoid lifelong treatment.

Dr. Silverman was formerly at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore and Lutherville, Maryland, and is now a cardiology fellow at Brigham and Women’s Hospital in Boston. He was quoted in a Johns Hopkins Medicine news release. The study was published online in the European Heart Journal.

The researchers explored two approaches to assessing the likelihood of cardiac problems: using such traditional risk factors as cholesterol, blood pressure, smoking status, and diabetes, or actually measuring the extent of atherosclerosis via coronary artery calcium scans.

Measuring won.

The researchers followed 6,698 adult participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Subjects did not have evidence of heart disease when they joined the study. They were assessed for risk factors and underwent a coronary artery calcium scan and then were followed for seven years.

“We found that 15 percent of people believed to be at very low risk actually had high coronary artery calcium scores, above 100, and were at relatively high risk of a cardiac event over the next seven years, said Roger Blumenthal, MD, a co-author of the study. Dr. Blumenthal is a Johns Hopkins professor of medicine and director of the Ciccarone Center.

“On the other hand,” he said, “35 percent of study participants thought to be at very high risk and needing aggressive therapy with aspirin and statin medication actually had no coronary artery calcium and an extremely low event rate over the next seven years. For them, we can emphasize lifestyle modifications.”

Related CME seminar (up to 12 AMA PRA Category 1 credits™): UCSF Cardiovascular & Pulmonary Imaging


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