Preventive cardiology
Effect of Patient Visualization of Coronary Calcium by Electron Beam Computed Tomography on Changes in Beneficial Lifestyle Behaviors

https://doi.org/10.1016/j.amjcard.2007.11.059Get rights and content

Despite convincing data demonstrating the benefits of aspirin (ASA), exercise, and dietary changes for both primary and secondary prevention of coronary heart disease, they remain underused. In this study, we assess whether higher coronary artery calcium (CAC) scores determined by electron beam computed tomography (EBCT) are associated with beneficial lifestyle behaviors in asymptomatic individuals. A total of 980 asymptomatic patients referred for EBCT risk assessment by their primary physician were sent a survey questioning them about health behaviors. We evaluated long-term ASA utilization, exercise, and dietary changes based on CAC using multivariable analysis. The study population consisted of 980 individuals (78% men, mean age 60 ± 8 years) who were followed for a mean of 3 ± 2 years after an initial EBCT scan. Overall, ASA initiation was lowest (29%) among those with CAC = 0, and gradually increased with higher CAC scores (1 to 99, 55%; 100 to 399, 61%; ≥400, 63%; p <0.001 for trend). Similarly, dietary changes and exercise were lowest (33% and 44%, respectively) among those with CAC = 0 and gradually increased with higher CAC scores (1 to 99, 40%; 100 to 399, 58%; ≥400, 56%; p <0.001 for trend for dietary changes; and 1 to 99, 62%; 100 to 399, 63%; ≥400, 67%; p <0.001 for trend for exercise). In multivariable analysis, greater baseline CAC was strongly associated with initiation of ASA therapy, dietary changes, and increased exercise. In conclusion, in addition to risk stratification of asymptomatic individuals, determination of CAC may also improve utilization of ASA therapy and behavioral modification.

Section snippets

Methods

A total of 1,215 consecutive asymptomatic patients referred for EBCT risk assessment by their primary physician were sent a survey questioning them about health behaviors. Demographic characteristics, hospitalizations, surgeries, physician-diagnosed diseases, current medications, including statin utilization, aspirin (ASA) use, and vitamin/antioxidant utilization, as well as lifestyle behaviors such as cigarette smoking, alcohol use, physical activity, and diet were determined using structured

Results

There were a total of 980 patients with complete follow-up information. The majority of the study population were men (n = 766, 78%). The mean age of the study population was 60 ± 8 years. These patients were followed for 3 ± 2 years (range 1 to 10 years).

The subjects were divided into 4 groups based on their CAC scores (i.e., CAC = 0, CAC = 1 to 99, CAC = 100 to 399, and CAC ≥400). Among our subjects, 234 (24%) had a CAC score of 0, 331 (33%) had a CAC score 1 to 99, 212 (22%) had a CAC score

Discussion

Our study shows that knowledge about the results of increased CAC on EBCT scan was significantly associated with initiation of risk-reducing behaviors. Subjects with EBCT scans showing increased CAC were more likely to initiate ASA use, participate in regular exercise, and have a healthy diet.

Despite extensive validation for the use of EBCT as a screening test to detect subclinical coronary artery disease, there is limited knowledge of the extent to which EBCT scan results motivate individuals

References (14)

There are more references available in the full text version of this article.

Cited by (99)

  • Is a Picture Worth a Thousand Words?

    2023, JACC: Cardiovascular Imaging
  • The use of coronary artery calcium scoring in young adults

    2023, Journal of Cardiovascular Computed Tomography
View all citing articles on Scopus
View full text