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Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

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ABSTRACT

BACKGROUND

Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized.

OBJECTIVES

We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes.

DESIGN

This study is a systematic review.

DATA SOURCES

We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions.

STUDY ELIGIBILITY CRITERIA

We included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease.

RESULTS

We identified four randomized controlled trials (RCT, n = 709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n = 2,994). In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p = 0.03) in one RCT. Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk. However, such data were conflicting and limited by the lack of a randomized control group. No studies examined the impact of screening on cardiovascular events or mortality. Heterogeneity in screening methods and studied outcomes did not permit pooling of results.

CONCLUSION

Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.

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References

  1. Greenland P, Smith SC Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001;104:1863–1867.

    Article  PubMed  CAS  Google Scholar 

  2. Smith SC Jr, Greenland P, Grundy SM. AHA Conference Proceedings. Prevention Conference V: Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention: Executive Summary. American Heart Association. Circulation. 2000;101:111–116.

    PubMed  Google Scholar 

  3. Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient—Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98:2H–15H.

    Article  PubMed  Google Scholar 

  4. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22.

    Article  PubMed  Google Scholar 

  5. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345.

    Article  PubMed  CAS  Google Scholar 

  6. Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300:197–208.

    Article  PubMed  CAS  Google Scholar 

  7. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–1616.

    Article  PubMed  CAS  Google Scholar 

  8. Lauer MS. Elements of danger—the case of medical imaging. N Engl J Med. 2009;361:841–843.

    Article  PubMed  CAS  Google Scholar 

  9. Young LH, Wackers FJ, Chyun DA, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD Study: a randomized controlled trial. JAMA. 2009;301:1547–1555.

    Article  PubMed  CAS  Google Scholar 

  10. Hlatky MA, Greenland P, Arnett DK, et al. Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119:2408–2416.

    Article  PubMed  Google Scholar 

  11. Bovet P, Perret F, Cornuz J, Quilindo J, Paccaud F. Improved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques. Prev Med. 2002;34:215–220.

    Article  PubMed  Google Scholar 

  12. Greenland P. Improving risk of coronary heart disease: can a picture make the difference? JAMA. 2003;289:2270–2272.

    Article  PubMed  Google Scholar 

  13. Screening for Asymptomatic Coronary Artery Disease: A Systematic Review for the U.S. Preventive Services Task Force Agency for Heathcare Research and Quality, 2003. (Accessed on 06/28/2011, at http://www.ahrq.gov/clinic/).

  14. O’Malley PG, Rupard EJ, Jones DL, Feuerstein I, Brazaitis M, Taylor AJ. Does the diagnosis of coronary calcification with electron beam computed tomography motivate behavioral change in smokers? Mil Med. 2002;167:211–214.

    PubMed  Google Scholar 

  15. Wong ND, Detrano RC, Diamond G, et al. Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviors? Am J Cardiol. 1996;78:1220–1223.

    Article  PubMed  CAS  Google Scholar 

  16. O’Malley PG, Feuerstein IM, Taylor AJ. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: a randomized controlled trial. JAMA. 2003;289:2215–2223.

    Article  PubMed  Google Scholar 

  17. Kalia NK, Miller LG, Nasir K, Blumenthal RS, Agrawal N, Budoff MJ. Visualizing coronary calcium is associated with improvements in adherence to statin therapy. Atherosclerosis. 2006;185:394–399.

    Article  PubMed  CAS  Google Scholar 

  18. Wyman RA, Gimelli G, McBride PE, Korcarz CE, Stein JH. Does detection of carotid plaque affect physician behavior or motivate patients? Am Heart J. 2007;154:1072–1077.

    Article  PubMed  Google Scholar 

  19. Khera A. Texas atherosclerosis imaging bill: quiet origins, broad implications. Arch Intern Med. 2011;171:281–283.

    Article  PubMed  Google Scholar 

  20. Determining the Role of Subclinical Disease Testing in Patients at Intermediate Risk: Report of the Working Group 2004 (Accessed on 06/28/2011, at http://www.nhlbi.nih.gov/meetings/workshops).

  21. Kalish GM, Bhargavan M, Sunshine JH, Forman HP. Self-referred whole-body imaging: where are we now? Radiology. 2004;233:353–358.

    Article  PubMed  Google Scholar 

  22. Ackerman T. Alarm sounded on heart scan law; Insurance must cover tests despite higher cancer risk. Houston Chronicle 2009.

  23. Jacobson PD. Transforming clinical practice guidelines into legislative mandates: proceed with abundant caution. JAMA. 2008;299:208–210.

    Article  PubMed  CAS  Google Scholar 

  24. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima–media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459–467.

    Article  PubMed  Google Scholar 

  25. Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008;51:1127–1147.

    Article  PubMed  Google Scholar 

  26. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40:1531–1540.

    Article  PubMed  Google Scholar 

  27. Brindis RG, Douglas PS, Hendel RC, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005;46:1587–1605.

    Article  PubMed  Google Scholar 

  28. Lefebvre C, Clarke M. Identifying randomized trials. In: Egger M, Davey Smith G, Altman D, eds. Systematic reviews in health care: meta-analysis in context. London: BMJ Publishing Group; 2001:69–86.

    Chapter  Google Scholar 

  29. Redberg RF, Vogel RA, Criqui MH, Herrington DM, Lima JA, Roman MJ. 34th Bethesda Conference: Task force #3—What is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J Am Coll Cardiol. 2003;41:1886–1898.

    Article  PubMed  Google Scholar 

  30. Mozaffarian D. Electron-beam computed tomography for coronary calcium: a useful test to screen for coronary heart disease? JAMA. 2005;294:2897–2901.

    Article  PubMed  CAS  Google Scholar 

  31. O’Malley PG. Atherosclerosis imaging of asymptomatic individuals: is the sales cart before the evidence horse? Arch Intern Med. 2006;166:1065–1068. discussion 71–2.

    Article  PubMed  Google Scholar 

  32. Obuchowski NA, Holden D, Modic MT, et al. Total-body screening: preliminary results of a pilot randomized controlled trial. J Am Coll Radiol. 2007;4:604–611.

    Article  PubMed  Google Scholar 

  33. Jüni P, Altman DG, Egger M. Assessing the quality of reports of systematic reviews. In: Egger M, Davey Smith G, Altman D, eds. Systematic reviews in health care: meta-analysis in context. London: BMJ Publishing Group; 2001:87–108.

    Chapter  Google Scholar 

  34. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.

    Article  PubMed  CAS  Google Scholar 

  35. Lederman J, Ballard J, Njike VY, Margolies L, Katz DL. Information given to postmenopausal women on coronary computed tomography may influence cardiac risk reduction efforts. J Clin Epidemiol. 2007;60:389–396.

    Article  PubMed  Google Scholar 

  36. Rodondi N, Auer R, Devine PJ, O’Malley PG, Hayoz D, Cornuz J. The impact of carotid plaque screening on motivation for smoking cessation. Nicotine Tob Res. 2008;10:541–546.

    Article  PubMed  Google Scholar 

  37. Korcarz CE, DeCara JM, Hirsch AT, et al. Ultrasound detection of increased carotid intima–media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation? J Am Soc Echocardiogr. 2008;21:1156–1162.

    Article  PubMed  Google Scholar 

  38. Orakzai RH, Nasir K, Orakzai SH, et al. Effect of patient visualization of coronary calcium by electron beam computed tomography on changes in beneficial lifestyle behaviors. Am J Cardiol. 2008;101:999–1002.

    Article  PubMed  CAS  Google Scholar 

  39. Sandwell JC, Wingard DL, Laughlin GA, Barrett-Connor E. Electron beam computed tomography screening and heart disease risk factor modification. Prev Cardiol. 2006;9:133–137.

    Article  PubMed  Google Scholar 

  40. Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB. Designing clinical research: an epidemiologic approach. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  41. Hollands GJ, Hankins M, Marteau TM. Visual feedback of individuals’ medical imaging results for changing health behaviour. Cochrane Database Syst Rev 2010:CD007434.

  42. Shahab L, Hall S, Marteau T. Showing smokers with vascular disease images of their arteries to motivate cessation: a pilot study. Br J Health Psychol. 2007;12:275–283.

    Article  PubMed  Google Scholar 

  43. Rodondi N, Bovet P, Hayoz D, Cornuz J. The Impact of CAROtid plaque Screening on Smoking (CAROSS) cessation and control of other cardiovascular risk factors: rationale and design of a randomized controlled trial. Contemp Clin Trials. 2008;29:767–773.

    Article  PubMed  Google Scholar 

  44. Sheridan SL, Viera AJ, Krantz MJ, et al. The effect of giving global coronary risk information to adults: a systematic review. Arch Intern Med. 2010;170:230–239.

    Article  PubMed  Google Scholar 

  45. Paddison CA, Eborall HC, Sutton S, et al. Are people with negative diabetes screening tests falsely reassured? Parallel group cohort study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2009;339:b4535.

    Article  PubMed  Google Scholar 

  46. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100:299–303.

    Article  PubMed  Google Scholar 

  47. Douglas PS, Taylor A, Bild D, et al. Outcomes research in cardiovascular imaging: report of a workshop sponsored by the National Heart, Lung, and Blood Institute. Circ Cardiovasc Imaging. 2009;2:339–348.

    Article  PubMed  Google Scholar 

  48. Greenland P, Alpert JS, Beller GA, et al. ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122:e584–e636.

    Article  PubMed  Google Scholar 

  49. U.S. Preventive Services Task Force. Using nontraditional risk factors in coronary heart disease risk assessment: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:474–482.

    Google Scholar 

  50. Emanuel EJ, Fuchs VR, Garber AM. Essential elements of a technology and outcomes assessment initiative. JAMA. 2007;298:1323–1325.

    Article  PubMed  CAS  Google Scholar 

  51. Redberg RF, Walsh J. Pay now, benefits may follow—the case of cardiac computed tomographic angiography. N Engl J Med. 2008;359:2309–2311.

    Article  PubMed  CAS  Google Scholar 

  52. Lovett KM, Liang BA. Direct-to-consumer cardiac screening and suspect risk evaluation. JAMA: J Am Med Assoc. 2011;305:2567–2568.

    Article  CAS  Google Scholar 

  53. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106:3143.

    Google Scholar 

  54. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333–3341.

    Article  Google Scholar 

  55. Assmann G, Cullen P, Fruchart JC, et al. Implications of emerging risk factors for therapeutic intervention. Nutr Metab Cardiovasc Dis. 2005;15:373–381.

    Article  PubMed  Google Scholar 

  56. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47:1239–1312.

    Article  PubMed  Google Scholar 

  57. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil. 2007;14(Suppl 2):S1–S113.

    Article  PubMed  Google Scholar 

  58. Perrone-Filardi P, Achenbach S, Mohlenkamp S, et al. Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology. Eur Heart J. 2010.

  59. Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation. 2010;122:e525–e555.

    Article  PubMed  Google Scholar 

  60. Dueling advice: New ACC/AHA risk assessment guidelines, SHAPE II released on same day. 2010 (Accessed on 06/28/2011, at http://www.theheart.org/article/1148755.do).

  61. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–832.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments/Funding

Dr. Rodondi’s and Dr. Cornuz’s researches on atherosclerosis screening, as well as a randomized controlled trial of atherosclerosis screening on smoking cessation (PI: Dr N. Rodondi), are supported by grants from the Swiss National Science Foundation (SNSF 3200B0-116097), the Swiss Tobacco Prevention Funds (Federal Office of Public Health, FPT 08.002282), and the Swiss Heart Foundation. Dr. Auer’s research on cardiovascular prevention is supported by grants from the Swiss National Science Foundation (SNSF SPUM 33CM30-124112 and PBLAP3-136774).

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland

    Nicolas Rodondi MD, MAS, Reto Auer MD, Vanessa de Bosset Sulzer MD, MPH & Jacques Cornuz MD, MPH

  2. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada

    William A. Ghali MD, MPH

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  1. Nicolas Rodondi MD, MAS
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  2. Reto Auer MD
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  3. Vanessa de Bosset Sulzer MD, MPH
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  4. William A. Ghali MD, MPH
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  5. Jacques Cornuz MD, MPH
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Correspondence to Nicolas Rodondi MD, MAS.

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Rodondi, N., Auer, R., de Bosset Sulzer, V. et al. Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review. J GEN INTERN MED 27, 220–231 (2012). https://doi.org/10.1007/s11606-011-1833-3

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  • DOI: https://doi.org/10.1007/s11606-011-1833-3

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