Coronary calcium scanning aids long-term CV risk factor control
MedWire News: The use of coronary artery calcium (CAC) scanning in asymptomatic individuals is associated with improved risk-factor control as compared with usual care, a randomized trial has found.
The EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging) investigators call for CAC scanning to be further investigated for its potential to improve cardiovascular (CV) risk and disease outcomes.
EISNER was a large clinical trial involving 2137 volunteers with CV risk factors but no known heart disease. They were randomly assigned to undergo CAC scanning or no scanning and followed-up for 4 years.
Importantly, all participants received personalized risk-factor counseling at baseline, which included a discussion of their CAC scores in the scanned group.
After 4 years, the scanned group, compared with the no-scan group, showed significantly better control of systolic blood pressure (-7 vs -5 mmHg); low-density lipoprotein (LDL) cholesterol (-17 vs -11 mg/dl); waist circumference for those with increased abdominal obesity (0 vs 1 inches); and weight among overweight individuals (0 vs 1 lbs).
Framingham Risk Scores (FRS) were unchanged over the 4-year study period in the scanned group but increased by 4.9 points in the no-scan group.
More detailed analysis also uncovered a suggestion of a dose-response effect within the scanned group, whereby higher CAC scores at baseline were associated with greater improvements in systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, weight, and FRS.
Furthermore, higher resource use for individuals with high CAC scores was counterbalanced by lower resource use for those with low CAC scores, meaning that overall downstream medical testing and associated costs were similar between the scanned and no-scan groups.
Drug costs were 7% higher in the scanned group, however, owing to the increased prescription of blood pressure and cholesterol drugs.
Commenting on the study, lead investigator Daniel Berman (Cedars-Sinai Medical Center, Los Angeles, California, USA) said: "By showing improved patient outcomes with scanning - without increasing the need for subsequent tests - the EISNER study will be very helpful in our quest to prevent heart attacks."
He adds: "The test isn't for everyone, but should be considered in patients with risk factors for coronary artery disease who are in the right age group."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Joanna Lyford