EISNER: CAC scanning associated with improved risk factors vs. no scanning

**Rozanski A. J Am Coll Cardiol. 2011; doi:10.1016/j.jacc.2011.01.019.**

Issue: May 2011

In a recent trial, middle-aged individuals with coronary artery disease risk factors who underwent coronary artery calcium scanning had superior coronary artery disease risk factor control without an increase in downstream medical testing compared with those who did not undergo scanning.

The Early Identification of Subclinical Atherosclerosis using Noninvasive Imaging Research (EISNER) trial included 2,137 volunteers (mean age, 58.5 ± 8.4 years) who underwent either coronary artery calcium (CAC) scanning (n=1,424) or no scanning (n=713). Patients had CAD risk factors at baseline and were excluded if they had a history of cardiac or cerebrovascular disease or chest pain, pregnancy, significant medical comorbidity, prior coronary catheterization or CAC scanning, or were aged 80 years or older. Four-year change in CAD risk factors and Framingham risk score was defined as the primary endpoint.

Compared with the no-scan group, those who underwent CAC scanning had a positive change in systolic BP (P=.02), waist circumference for those with increased abdominal girth (P=.01) and LDL cholesterol (P=.04), as well as a tendency for weight loss among overweight individuals (P=.07). Although there was a rise in Framingham risk score in the no-scan group, it remained unchanged in the scan group (P=.003).

Furthermore, for the scan group, increasing baseline CAC score was linked with improvements in a dose-response for systolic and diastolic BP, total cholesterol, triglycerides, weight and LDL (P<.001 for all), as well as Framingham risk score (P=.003). Downstream medical testing and costs were found to be comparable between groups.

“The results of our trial are consistent with the hypothesis that CAC scanning can improve cardiac management without incurring significant increase in downstream medical costs,” the researchers wrote. “The results … indicate a need for future large-scale clinical trials to determine whether our findings are applicable to different patient populations and to determine whether the salutatory effect of CAC scanning on CAD risk profiles translates to reductions in adverse clinical events.”

These trials, they said, should evaluate outcomes after CAC scanning according to the efficacy and intensity of medications used to control CAD risk factors, as well as the quality and intensity of behavioral interventions instituted after CAC scanning.

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