Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes.
This study is a systematic review.
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.
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.
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.
- 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. CrossRef
- 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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Lauer MS. Elements of danger—the case of medical imaging. N Engl J Med. 2009;361:841–843. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Greenland P. Improving risk of coronary heart disease: can a picture make the difference? JAMA. 2003;289:2270–2272. CrossRef
- 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/).
- 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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Khera A. Texas atherosclerosis imaging bill: quiet origins, broad implications. Arch Intern Med. 2011;171:281–283. CrossRef
- 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).
- Kalish GM, Bhargavan M, Sunshine JH, Forman HP. Self-referred whole-body imaging: where are we now? Radiology. 2004;233:353–358. CrossRef
- Ackerman T. Alarm sounded on heart scan law; Insurance must cover tests despite higher cancer risk. Houston Chronicle 2009.
- Jacobson PD. Transforming clinical practice guidelines into legislative mandates: proceed with abundant caution. JAMA. 2008;299:208–210. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Mozaffarian D. Electron-beam computed tomography for coronary calcium: a useful test to screen for coronary heart disease? JAMA. 2005;294:2897–2901. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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.
- Hollands GJ, Hankins M, Marteau TM. Visual feedback of individuals’ medical imaging results for changing health behaviour. Cochrane Database Syst Rev 2010:CD007434.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100:299–303. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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.
- Emanuel EJ, Fuchs VR, Garber AM. Essential elements of a technology and outcomes assessment initiative. JAMA. 2007;298:1323–1325. CrossRef
- Redberg RF, Walsh J. Pay now, benefits may follow—the case of cardiac computed tomographic angiography. N Engl J Med. 2008;359:2309–2311. CrossRef
- Lovett KM, Liang BA. Direct-to-consumer cardiac screening and suspect risk evaluation. JAMA: J Am Med Assoc. 2011;305:2567–2568. CrossRef
- 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.
- American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333–3341. CrossRef
- Assmann G, Cullen P, Fruchart JC, et al. Implications of emerging risk factors for therapeutic intervention. Nutr Metab Cardiovasc Dis. 2005;15:373–381. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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.
- 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. CrossRef
- 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).
- 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. CrossRef
- Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review
Journal of General Internal Medicine
Volume 27, Issue 2 , pp 220-231
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- diagnostic techniques
- coronary disease
- health behavior
- smoking cessation
- clinical trial
- systematic review
- Industry Sectors
- Author Affiliations
- 1. Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland
- 2. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada