Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Apr 12;57(15):1622-32.
doi: 10.1016/j.jacc.2011.01.019.

Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial

Alan Rozanski  1 , Heidi Gransar, Leslee J Shaw, Johanna Kim, Lisa Miranda-Peats, Nathan D Wong, Jamal S Rana, Raza Orakzai, Sean W Hayes, John D Friedman, Louise E J Thomson, Donna Polk, James Min, Matthew J Budoff, Daniel S Berman
Affiliations
Randomized Controlled Trial

Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial

Alan Rozanski et al. J Am Coll Cardiol. .

Abstract

Objectives: We conducted a prospective randomized trial to compare the clinical impact of conventional risk factor modification to that associated with the addition of coronary artery calcium (CAC) scanning.

Background: Although CAC scanning predicts cardiac events, its impact on subsequent medical management and coronary artery disease risk is not known.

Methods: We assigned 2,137 volunteers to groups that either did undergo CAC scanning or did not undergo CAC scanning before risk factor counseling. The primary end point was 4-year change in coronary artery disease risk factors and Framingham Risk Score. We also compared the groups for differences in downstream medical resource utilization.

Results: Compared with the no-scan group, the scan group showed a net favorable change in systolic blood pressure (p = 0.02), low-density lipoprotein cholesterol (p = 0.04), and waist circumference for those with increased abdominal girth (p = 0.01), and tendency to weight loss among overweight subjects (p = 0.07). While there was a mean rise in Framingham Risk Score (FRS) in the no-scan group, FRS remained static in the scan group (0.7 ± 5.1 vs. 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), low-density lipoprotein cholesterol (p < 0.001), triglycerides (p < 0.001), weight (p < 0.001), and Framingham Risk Score (p = 0.003). Downstream medical testing and costs in the scan group were comparable to those of the no-scan group, balanced by lower and higher resource utilization for subjects with normal CAC scans and CAC scores ≥400, respectively.

Conclusions: Compared with no scanning, randomization to CAC scanning was associated with superior coronary artery disease risk factor control without increasing downstream medical testing. Further study of CAC scanning, including pre-specified treatment recommendations, to assess its impact of cardiovascular outcomes is warranted.

Trial registration: ClinicalTrials.gov NCT00927693.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Summary of trial design and disposition of subjects at four-year follow-up. CAC = coronary artery calcium.
See this image and copyright information in PMC

Comment in

References

    1. Shaw LS, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors & coronary artery calcium screening for all cause mortality. Radiology. 2003;228:826–833. - PubMed
    1. Kondos GT, Hoff JA, Sevrukov A, et al. Coronary artery calcium and cardiac events electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5,635 initially asymptomatic low to intermediate risk adults. Circulation. 2003;107:2571–2576. - PubMed
    1. Arad Y, Goodman KJ, Roth M, et al. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events. J Am Coll Cardiol. 2005;46:158–65. - PubMed
    1. Detrano R, Guerci AD, Carr JC, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:13336–45. - PubMed
    1. Wilson PWF, D’Agostino RB, Levy D, Belanger AB, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47. - PubMed

Publication types

Associated data