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September 24, 2003

Screening for Coronary Calcification—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(12):1576. doi:10.1001/jama.290.12.1576-a

In Reply: We generally agree with Drs Sabaté and Yach that a dynamic process of adherence requiring individualized attention, among other factors, is necessary to enact behavioral change. We also agree that the process of behavioral interventions by experienced and appropriately trained clinicians is a first step in the process of motivation to change. However, we also believe that alternative approaches to enhance behavioral interventions should continue to be tested. Current methods to modify risk in primary prevention involve resource-intensive efforts whose efficacy and cost-effectiveness for reducing morbidity and mortality remains largely unknown. Such objective information about preclinical disease in the context of an ongoing patient-physician relationship might help to support behavioral interventions. For example, in a subgroup of participants with cardiac calcification in our study, there was a trend toward improved risk profile when calcification data was included in the process of care. We suspect that the detection and presentation of objective subclinical disease can have a motivational effect in the right setting. This hypothesis requires further study in higher-risk, asymptomatic populations with a higher prevalence of significant calcification.1

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