Coronary artery calcium scanning before risk factor counseling prevented the 4-year increase in Framingham Risk Score observed in the no-scan group (0.002 vs 0.7; P=0.003).
RCT (n=2,137)
Absolute Event Rate: 0.002% vs 0.7%
p-value: p=0.003
We conducted a prospective randomized trial to compare the clinical impact of conventional risk factor modification to that associated with coronary artery calcium (CAC) scanning. Although CAC scanning predicts cardiac events, its impact on subsequent medical management and CAD risk is not known. We assigned 2,137 volunteers to groups that did versus did not undergo CAC scanning before risk factor counseling. The primary end-point was 4-year change in CAD risk factors and Framingham Risk Score (FRS). We also compared the groups for differences in downstream medical resource utilization. Compared to the no-scan group, the scan group showed a net favorable change in systolic blood pressure (p=0.02), LDL-cholesterol (p=0.04), waist circumference for those with increased abdominal girth (p=0.01), and tendency to weight loss among overweight subjects (p=0.07). While mean FRS rose in the no-scan group, it remained static in the scan group (0.7±5.1 versus 0.002±4.9, p=0.003). Within the scan group, increasing baseline CAC score was associated with a dose-response improvement in systolic and diastolic blood pressure (p<0.001), total cholesterol (p<0.001), LDL-cholesterol (p<0.001), triglycerides (p<0.001), weight (p<0.001) and FRS (p=0.003). Downstream medical testing and costs in the scan group were comparable versus the no-scan group, balanced by lower and higher resource utilization for those with normal CAC scans and CAC scores ≥400, respectively. As compared to no scanning, randomization to CAC scanning was associated with superior CAD risk factor control without increasing downstream medical testing. Further study of CAC scanning for improvement of cardiovascular outcomes may be warranted. (ClinicalTrials.gov, number NCT00927693 ). Keywords: coronary calcification, risk factors, coronary artery disease, prevention
“In our study, patients who knew their coronary calcium scores improved their coronary heart disease risk compared with those with no scan, and those with high calcium scores were motivated to take even more aggressive steps to reduce their risk.”
Rozanski et al. (Fri,) conducted a rct in Coronary artery disease risk factors (n=2,137). Coronary artery calcium (CAC) scanning vs. No CAC scanning was evaluated on 4-year change in CAD risk factors and Framingham Risk Score (FRS) (p=0.003). Coronary artery calcium scanning before risk factor counseling prevented the 4-year increase in Framingham Risk Score observed in the no-scan group (0.002 vs 0.7; P=0.003).