The Case For and Against a Coronary Artery Calcium Trial: Means, Motive, and Opportunity

John W. McEvoy, Seth Martin, Michael Blaha, Tamar S. Polonsky, Khurram Nasir, Sanjay Kaul, Philip Greenland, Roger S Blumenthal

Research output: Contribution to journalReview article

Abstract

Numerous observational studies have shown that coronary artery calcium (CAC) imaging can improve cardiovascular risk assessment in asymptomatic adults. Whether CAC imaging can improve cardiovascular outcomes as part of an overall risk reduction strategy compared to alternative care approaches has not been demonstrated in clinical trials. Therefore, the role of CAC imaging in primary prevention of cardiovascular disease is somewhat contentious. Advocates for expanded CAC testing offer the large amount of observational data as support for their position, while opponents to wider CAC testing propose that only a clinical trial can resolve the matter. This paper reviews the arguments for and against such a trial based on clinical, safety and economic considerations. We also propose potential trial approaches based on recent changes in clinical practice that could make a new CAC trial design feasible.

Original languageEnglish (US)
Pages (from-to)994-1002
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume9
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Coronary Vessels
Calcium
Clinical Trials
Risk Reduction Behavior
Primary Prevention
Observational Studies
Cardiovascular Diseases
Economics
Safety

Keywords

  • coronary artery calcification
  • outcomes
  • randomized controlled trial

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

The Case For and Against a Coronary Artery Calcium Trial : Means, Motive, and Opportunity. / McEvoy, John W.; Martin, Seth; Blaha, Michael; Polonsky, Tamar S.; Nasir, Khurram; Kaul, Sanjay; Greenland, Philip; Blumenthal, Roger S.

In: JACC: Cardiovascular Imaging, Vol. 9, No. 8, 01.08.2016, p. 994-1002.

Research output: Contribution to journalReview article

McEvoy, John W. ; Martin, Seth ; Blaha, Michael ; Polonsky, Tamar S. ; Nasir, Khurram ; Kaul, Sanjay ; Greenland, Philip ; Blumenthal, Roger S. / The Case For and Against a Coronary Artery Calcium Trial : Means, Motive, and Opportunity. In: JACC: Cardiovascular Imaging. 2016 ; Vol. 9, No. 8. pp. 994-1002.
@article{4df8b022561440c38b10a8ef94f70e37,
title = "The Case For and Against a Coronary Artery Calcium Trial: Means, Motive, and Opportunity",
abstract = "Numerous observational studies have shown that coronary artery calcium (CAC) imaging can improve cardiovascular risk assessment in asymptomatic adults. Whether CAC imaging can improve cardiovascular outcomes as part of an overall risk reduction strategy compared to alternative care approaches has not been demonstrated in clinical trials. Therefore, the role of CAC imaging in primary prevention of cardiovascular disease is somewhat contentious. Advocates for expanded CAC testing offer the large amount of observational data as support for their position, while opponents to wider CAC testing propose that only a clinical trial can resolve the matter. This paper reviews the arguments for and against such a trial based on clinical, safety and economic considerations. We also propose potential trial approaches based on recent changes in clinical practice that could make a new CAC trial design feasible.",
keywords = "coronary artery calcification, outcomes, randomized controlled trial",
author = "McEvoy, {John W.} and Seth Martin and Michael Blaha and Polonsky, {Tamar S.} and Khurram Nasir and Sanjay Kaul and Philip Greenland and Blumenthal, {Roger S}",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.jcmg.2016.03.012",
language = "English (US)",
volume = "9",
pages = "994--1002",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - The Case For and Against a Coronary Artery Calcium Trial

T2 - Means, Motive, and Opportunity

AU - McEvoy, John W.

AU - Martin, Seth

AU - Blaha, Michael

AU - Polonsky, Tamar S.

AU - Nasir, Khurram

AU - Kaul, Sanjay

AU - Greenland, Philip

AU - Blumenthal, Roger S

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Numerous observational studies have shown that coronary artery calcium (CAC) imaging can improve cardiovascular risk assessment in asymptomatic adults. Whether CAC imaging can improve cardiovascular outcomes as part of an overall risk reduction strategy compared to alternative care approaches has not been demonstrated in clinical trials. Therefore, the role of CAC imaging in primary prevention of cardiovascular disease is somewhat contentious. Advocates for expanded CAC testing offer the large amount of observational data as support for their position, while opponents to wider CAC testing propose that only a clinical trial can resolve the matter. This paper reviews the arguments for and against such a trial based on clinical, safety and economic considerations. We also propose potential trial approaches based on recent changes in clinical practice that could make a new CAC trial design feasible.

AB - Numerous observational studies have shown that coronary artery calcium (CAC) imaging can improve cardiovascular risk assessment in asymptomatic adults. Whether CAC imaging can improve cardiovascular outcomes as part of an overall risk reduction strategy compared to alternative care approaches has not been demonstrated in clinical trials. Therefore, the role of CAC imaging in primary prevention of cardiovascular disease is somewhat contentious. Advocates for expanded CAC testing offer the large amount of observational data as support for their position, while opponents to wider CAC testing propose that only a clinical trial can resolve the matter. This paper reviews the arguments for and against such a trial based on clinical, safety and economic considerations. We also propose potential trial approaches based on recent changes in clinical practice that could make a new CAC trial design feasible.

KW - coronary artery calcification

KW - outcomes

KW - randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85008701918&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85008701918&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2016.03.012

DO - 10.1016/j.jcmg.2016.03.012

M3 - Review article

C2 - 27491486

AN - SCOPUS:85008701918

VL - 9

SP - 994

EP - 1002

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 8

ER -