Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Calcium
Scans may be effective Screening Tool for
Heart Disease
Newswise — A simple, non-invasive test
appears to be an effective screening tool
for identifying patients with silent heart
disease who are at risk for a heart attack
or sudden death.
Coronary artery calcium scans can be done
without triggering excessive additional
testing and costs, according to the
multi-center EISNER (Early Identification of
Subclinical Atherosclerosis by Noninvasive
Imaging Research) study, led by
investigators at the Cedars-Sinai Heart
Institute.
The findings appear in today’s issue of the
Journal of the American College of
Cardiology.
Coronary artery calcium scans that detect
plaque in the coronary arteries have been
shown to be more effective than standard
cholesterol and blood pressure measurements
in identifying patients who are most
vulnerable to heart disease.
Currently, these scans are not covered by
private insurance carriers, in part because
of concerns that detection of low levels of
cardiovascular disease will result in
unnecessary and expensive further testing,
including exercise imaging and invasive
cardiac catheterization procedures.
“Over half of patients who suffer heart
attacks have no warning that they have heart
disease until the heart attack occurs.
"If
we knew the patients were at risk, current
treatments could prevent the majority of
these unnecessary events.
"We
had to address the concerns about
unnecessary testing and costs related to
this potentially lifesaving procedure,” said
Daniel S. Berman, M.D., the study’s
principal investigator and chief of Cardiac
Imaging at Cedars-Sinai’s S. Mark Taper
Foundation Imaging Center in Los Angeles.
In the EISNER study, supported by The Eisner
Foundation, researchers performed coronary
calcium scans on 1,361 volunteers at
intermediate risk for coronary artery
disease, and followed them over a four-year
period, from May 2001 to June 2005.
The objective was to determine the
relationship between coronary artery calcium
scores and subsequent cardiac events and to
evaluate the performance of additional
cardiac diagnostic testing.
Coronary artery calcium scores of 0 indicate
no plaque, 1-9 minimal, 10-99 mild, 100-399
moderate, 400-999 extensive, and 1,000 or
more very extensive plaque.
Coronary artery calcium scores varied widely
but the vast majority of the patients had
low scores. More than half — 56.7 percent of
subjects -- had scores of less than 10, and
only 8.2 percent had scores higher than 400.
There was a strong relationship between the
coronary calcium scores and subsequent
cardiac events.
The unique finding of the EISNER study was
that there was a marked difference in the
number, type and frequency of medical tests
and costs given a subject’s coronary artery
calcium score.
Additional
stress testing was infrequent and related
costs were low among subjects with low
coronary artery calcium scores.
Both rose progressively as the coronary
artery calcium score increased, particularly
in the patients at highest risk—those with
scores of greater than 1,000—found in only
2.2 percent of subjects (31).
Importantly, catheter-based invasive
coronary angiography was performed
exclusively among subjects with high
coronary artery calcium scores.
And even then, only 19.4 percent of
participants who were in the highest risk
category underwent this expensive procedure
associated with a small but definite risk.
Recent evidence has demonstrated that
screening with coronary artery calcium is a
better prognosticator of risk than the
Framingham Risk Score—the traditional way of
assessing risk based on blood testing and
blood pressure--in middle aged and elderly
patients.
Yet
controversy surrounds expansion of cardiac
screening to include coronary calcium
scanning imaging because of concerns that
the extra costs may not outweigh the
benefits.
The findings of the EISNER study, the
researchers note, is the first direct
evidence that coronary artery calcium
scanning could be an acceptable
cost-effective screening test for coronary
artery disease, since it is able to identify
high risk subgroups in need of aggressive
medical treatment, and patients who undergo
additional testing constitute only a small
fraction of the screened population.
The study was funded by a grant from The
Eisner Foundation, a private philanthropy in
Los Angeles.
Financial Disclosures: Leslee J. Shaw, M.D.,
of the Emory University School of Medicine
in Atlanta, has received grant support from
GE Healthcare (which makes one of the
imaging machines used in the study); Matthew
Budoff, M.D., of the Los Angeles Biomedical
Research Institute, Harbor-UCLA Medical
Center in Torrance, has served as a
consultant for GE Healthcare; James K. Min,
M.D., of Weill Medical College of Cornell
University inn New York, has served on the
Speakers’ Bureau for and received research
support from GE Healthcare; Daniel S.
Berman, M.D., has received research support
from GE Healthcare.
... ..
...
...