Selective Use of Coronary Artery Calcium Testing for Shared Decision Making: Guideline Endorsed and Ready for Prime Time

Ideas and Opinions19 February 2019Selective Use of Coronary Artery Calcium Testing for Shared Decision Making: Guideline Endorsed and Ready for Prime TimeRhanderson Cardoso, MD, Khurram Nasir, MD, MPH, MSc, Roger S. Blumenthal, MD, and Michael J. Blaha, MD, MPHRhanderson Cardoso, MDThe Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (R.C., R.S.B., M.J.B.)Search for more papers by this author, Khurram Nasir, MD, MPH, MScCenter for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, and The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (K.N.)Search for more papers by this author, Roger S. Blumenthal, MDThe Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (R.C., R.S.B., M.J.B.)Search for more papers by this author, and Michael J. Blaha, MD, MPHThe Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (R.C., R.S.B., M.J.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3675 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The use of traditional risk factors and laboratory markers to estimate 10-year risk for atherosclerotic cardiovascular disease (ASCVD) remains the cornerstone of clinical decision making for primary prevention of ASCVD in asymptomatic persons. In the United States, risk estimation begins with the pooled cohort equations, which were first introduced in the 2013 American Heart Association and American College of Cardiology (AHA/ACC) prevention guideline. The new 2018 AHA/ACC guideline still recommends use of these equations as a prudent first step in clinical decision making, despite acknowledging that they provide only moderate risk discrimination and may overestimate risk (1, 2).Since publication ...References1. DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162:266-75. [PMID: 25686167]. doi:10.7326/M14-1281 LinkGoogle Scholar2. Cook NR, Ridker PM. Calibration of the pooled cohort equations for atherosclerotic cardiovascular disease: an update. Ann Intern Med. 2016;165:786-94. [PMID: 27723890]. doi:10.7326/M16-1739 LinkGoogle Scholar3. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018. [PMID: 30423393] doi:10.1016/j.jacc.2018.11.003 CrossrefMedlineGoogle Scholar4. Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2018. [PMID: 30423392] doi:10.1016/j.jacc.2018.11.005 CrossrefMedlineGoogle Scholar5. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. J Am Coll Cardiol. 2018;72:434-47. [PMID: 30025580] doi:10.1016/j.jacc.2018.05.027 CrossrefMedlineGoogle Scholar6. Blaha MJ, Blumenthal RS, Budoff MJ, Nasir K. Understanding the utility of zero coronary calcium as a prognostic test: a Bayesian approach. Circ Cardiovasc Qual Outcomes. 2011;4:253-6. [PMID: 21406674] doi:10.1161/CIRCOUTCOMES.110.958496 CrossrefMedlineGoogle Scholar7. Nasir K, Bittencourt MS, Blaha MJ, Blankstein R, Agatson AS, Rivera JJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2015;66:1657-68. [PMID: 26449135] doi:10.1016/j.jacc.2015.07.066 CrossrefMedlineGoogle Scholar8. Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016;133:849-58. [PMID: 26801055] doi:10.1161/CIRCULATIONAHA.115.018524 CrossrefMedlineGoogle Scholar9. Nasir K. Message for 2018 cholesterol management guidelines update: time to accept the power of zero [Editorial]. J Am Coll Cardiol. 2018;72:3243-5. [PMID: 30409568] doi:10.1016/j.jacc.2018.10.006 CrossrefMedlineGoogle Scholar10. Roberts ET, Horne A, Martin SS, Blaha MJ, Blankstein R, Budoff MJ, et al. Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One. 2015;10:e0116377. [PMID: 25786208] doi:10.1371/journal.pone.0116377 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (R.C., R.S.B., M.J.B.)Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, and The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland (K.N.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3675.Corresponding Author: Michael J. Blaha, MD, MPH, Johns Hopkins Medical Institutions, Blalock 524D1, 600 N. Wolfe Street, Baltimore, MD 21287; e-mail, [email protected]edu.Current Author Addresses: Dr. Cardoso: Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Halsted 500, Baltimore, MD 21287.Dr. Nasir: Yale Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510.Dr. Blumenthal: Johns Hopkins Hospital, 600 N. Wolfe Street, Halsted 560, Ciccarone Center, Baltimore, MD 21287.Dr. Blaha: Johns Hopkins Medical Institutions, Blalock 524D1, 600 N. Wolfe Street, Baltimore, MD 21287.Author Contributions: Conception and design: R. Cardoso, K. Nasir, R.S. Blumenthal, M.J. Blaha.Analysis and interpretation of the data: K. Nasir, R.S. Blumenthal, M.J. Blaha.Drafting of the article: R. Cardoso, K. Nasir, M.J. Blaha.Critical revision of the article for important intellectual content: R. Cardoso, K. Nasir, R.S. Blumenthal, M.J. Blaha.Final approval of the article: R. Cardoso, K. Nasir, R.S. Blumenthal, M.J. Blaha.Administrative, technical, or logistic support: R. Cardoso, M.J. Blaha.Collection and assembly of data: K. Nasir.This article was published at Annals.org on 12 February 2019. 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