, Volume 27, Issue 2, pp 220-231
Date: 01 Sep 2011

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.

Previous presentation: Preliminary results were presented at the SGIM 33rd Annual Meeting, April 2010, in Minneapolis.