A new study shows that coronary artery calcium (CAC) screening, an assessment tool that is not currently recommended for people considered at low risk, should play a more prominent role in helping determine a person's risk for heart attack and heart disease-related death, as well as the need for angioplasty or bypass surgery. CAC screening provides a direct measure of calcium deposits in heart arteries and is easily obtained on a computed tomography (CT) scan.
"We showed that by using only the traditional risk factors, we miss a significant percentage of individuals at high risk. We may also be over-treating a large number of people who can safely avoid lifelong treatment," says lead author Michael G. Silverman, M.D., who formerly worked at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and is now a cardiology fellow at Brigham and Women's Hospital in Boston.
In the study published online on Dec. 23 in the European Heart Journal, the researchers compared two approaches to risk assessment. One approach looked only at risk factors including cholesterol, blood pressure, current smoking and diabetes. The other used the direct measurement of atherosclerosis as seen on the coronary artery calcium score.
"Our study, using data from almost 7,000 adult participants in the Multi-Ethnic Study of Atherosclerosis (MESA), shows that coronary artery calcium screening provides an accurate, personalized assessment for those who, by traditional risk factors, are at either high or low risk of a heart attack or death from coronary artery disease," says Khurram Nasir, M.D., M.P.H., the study's senior author and director of wellness and prevention research at Baptist Health Medical Group in Miami. Nasir is also an adjunct faculty member at the Johns Hopkins University School of Medicine.
The MESA participants did not have evidence of heart disease when they joined the study between 2000 and 2002. They were assessed for risk factors and had a coronary calcium scan and were followed for a mean of 7.1 years for coronary heart disease events, such as heart attacks.