Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review

doi:10.1007/s11606-011-1833-3

. 2012 Feb;27(2):220-31.

doi: 10.1007/s11606-011-1833-3. Epub 2011 Sep 1.

Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review

Nicolas Rodondi¹, Reto Auer, Vanessa de Bosset Sulzer, William A Ghali, Jacques Cornuz

Affiliations

PMID: 21882076
PMCID: PMC3270245
DOI: 10.1007/s11606-011-1833-3

Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review

Nicolas Rodondi et al. J Gen Intern Med. 2012 Feb.

. 2012 Feb;27(2):220-31.

doi: 10.1007/s11606-011-1833-3. Epub 2011 Sep 1.

Authors

Nicolas Rodondi¹, Reto Auer, Vanessa de Bosset Sulzer, William A Ghali, Jacques Cornuz

Affiliation

¹ Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland. Nicolas.Rodondi@insel.ch

PMID: 21882076
PMCID: PMC3270245
DOI: 10.1007/s11606-011-1833-3

Abstract

Background: Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized.

Objectives: We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes.

Design: This study is a systematic review.

Data sources: We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions.

Study eligibility criteria: We included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease.

Results: We identified four randomized controlled trials (RCT, n=709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n=2,994). In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p=0.03) in one RCT. Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk. However, such data were conflicting and limited by the lack of a randomized control group. No studies examined the impact of screening on cardiovascular events or mortality. Heterogeneity in screening methods and studied outcomes did not permit pooling of results.

Conclusion: Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.

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Figures

**Figure. 1**
Flowchart of included studies. *CVD* cardiovascular disease.

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References

1. Greenland P, Smith SC, Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001;104:1863–1867. doi: 10.1161/hc4201.097189. - DOI - PubMed
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1. Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient—Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98:2H–15H. doi: 10.1016/j.amjcard.2006.03.002. - DOI - PubMed
1. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK., Jr Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22. doi: 10.1056/NEJM199901073400103. - DOI - PubMed
1. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345. doi: 10.1056/NEJMoa072100. - DOI - PubMed

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[1] Greenland P, Smith SC, Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001;104:1863–1867. doi: 10.1161/hc4201.097189. - DOI - PubMed

[2] Greenland P, Smith SC, Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001;104:1863–1867. doi: 10.1161/hc4201.097189. - DOI - PubMed

[3] Smith SC, Jr, Greenland P, Grundy SM. AHA Conference Proceedings. Prevention Conference V: Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention: Executive Summary. American Heart Association. Circulation. 2000;101:111–116. - PubMed

[4] Smith SC, Jr, Greenland P, Grundy SM. AHA Conference Proceedings. Prevention Conference V: Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention: Executive Summary. American Heart Association. Circulation. 2000;101:111–116. - PubMed

[5] Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient—Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98:2H–15H. doi: 10.1016/j.amjcard.2006.03.002. - DOI - PubMed

[6] Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient—Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98:2H–15H. doi: 10.1016/j.amjcard.2006.03.002. - DOI - PubMed

[7] O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK., Jr Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22. doi: 10.1056/NEJM199901073400103. - DOI - PubMed

[8] O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK., Jr Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22. doi: 10.1056/NEJM199901073400103. - DOI - PubMed

[9] Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345. doi: 10.1056/NEJMoa072100. - DOI - PubMed

[10] Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345. doi: 10.1056/NEJMoa072100. - DOI - PubMed

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Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review

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