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December 14, 2009

A Double Take on Serial Measurement of Coronary Artery Calcification

Arch Intern Med. 2009;169(22):2051-2052. doi:10.1001/archinternmed.2009.418

Any screening for coronary artery calcification (CAC) for primary prevention of cardiovascular disease (CVD) is still an unproven strategy to improve health outcomes.1 A brief summary of the evidence to date would conclude that CAC, measured with fast computed tomography (CT) protocols, is a valid marker of underlying atherosclerosis, correlates with the burden of coronary atherosclerosis, confers independent added prognostic value to conventional risk prediction, and may be valuable in refining risk prediction in such a way as to alter decision making about medical therapies (although, to my knowledge, there is no randomized trial evidence to prove this).1-5 However, there is ample reason to be wary of screening for CAC. First, we do not know whether it results in improved outcomes. One randomized trial that tested its motivational effect did not show any improvement on cardiovascular risk factors.6 There is potential harm due to radiation exposure, incidental findings, unnecessary induced interventions (sometimes invasive), insurability, quality-of-life decrements associated with labeling and medicalization of asymptomatic populations, and cost.7,8 One decision analysis using favorable assumptions toward screening coronary CT in low-risk populations indicated that, at best, it is a very expensive endeavor, and, more likely, it is a tragic waste of money.8

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