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CVD preventive strategies more prevalent in nonzero CAC score
Patients with identified calcified coronary plaque were more likely to be treated with pharmacotherapies and lifestyle changes to prevent CVD compared with those with a coronary artery calcium score of zero, according to a review and meta-analysis.
Ankur Gupta, MD, PhD, a clinical fellow in radiology at Brigham and Women’s Hospital in Boston, and colleagues analyzed data from six studies with 11,256 patients aged 43 to 65 years. The studies that were featured evaluated the effects of CAC scores on medication and lifestyle therapies to prevent CVD. Patients were followed up between 1.6 and 6 years.
Those with nonzero CAC scores had higher pooled estimates for lipid-lowering medication initiation (OR = 2.9; 95% CI, 1.9-4.4), aspirin initiation (OR = 2.6; 95% CI, 1.8-3.8) and BP-lowering medication initiation (OR = 1.9; 95% CI, 1.6-2.3) compared with patients with zero CAC.
Pooled estimates showed that patients with nonzero CAC were more likely to continue pharmacological therapy compared with those with zero CAC, specially lipid-lowering medication (OR = 2.3; 95% CI, 1.6-3.3). Estimates for the continuation of aspirin and BP-lowering medications were not elevated in the nonzero CAC group.
Estimates of odds of increases in dietary change (OR = 1.9; 95% CI, 1.5-2.5) and exercise (OR = 1.8; 95% CI, 1.4-2.4) were higher in nonzero CAC vs. zero CAC scores.
“An area of concern in advocating the use of CAC scanning among asymptomatic patients is the risk of downstream testing and increases in health care costs,” Gupta and colleagues wrote.
“This is an important observation because of the difficulty of implementing risk factor interventions in asymptomatic individuals at increased risk for [CV] events,” David J. Maron, MD, clinical professor of cardiovascular medicine and director of preventive cardiology at Stanford University, wrote in a related editorial. “It appears that the detection of CAC may motivate providers and/or patients to implement evidence-based therapies to prevent events when knowing the cholesterol or [BP] level may not so motivate.” – by Darlene Dobkowski
Disclosures: Gupta and Maron report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.