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Data insufficient for routine CAC screening
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NEW ORLEANS — Promotion of routine coronary artery calcium screening for all middle-aged and older adults is unwise, given the lack of data from randomized controlled trials about its safety or efficacy, Michael Lauer, MD, said Monday.
Lauer, who presented the Ancel Keys Memorial Lecture, said the argument in favor of routine screening is based on logic and epidemiologic observational data. “The history of failures in medicine has been based on logic,” he said, citing the long-held “logical” assumption that postmenopausal hormone therapy was safe and efficacious. That assumption was debunked by evidence-based trials, he said.
The “logic is strong” that CAC screening in asymptomatic adults would be useful, he said, but physicians “do not know whether it would prevent major coronary artery events. Logic cannot be relied on,” said Lauer, director of the division of prevention and population science at the National Heart, Lung, and Blood Institute in Bethesda.
“While it is true that coronary artery calcium scores correlate well with clinical events, the evidence-base has not yet reached the level of established tests. We may fall into a too often ignored trap, where strategies based on logic or risk markers turn out to be ineffective or even dangerous.”
Lauer argued that making the right judgment about CAC screening must rely on evidence derived from robust clinical trials. “Supposing is good, but finding out is better.”