Noninvasive cardiovascular imaging in primary prevention: Does it influence management and outcomes?

Excerpt

Recently, the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) Task Force on Practice Guidelines released their recommendations for the assessment of cardiovascular risk in asymptomatic adults.1 In this guideline, measurement of coronary artery calcium (CAC) with computed tomography (CT) imaging received a Class IIa recommendation stating that “measurement of CAC is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10% to 20% 10-year risk).” The Class IIa recommendation implies that the benefit is greater or equal to the risk but that additional studies with broad objectives are needed or additional registry data would be helpful. Until further evidence is forthcoming, the procedure/treatment may be considered. CAC imaging in patients at low risk (<6% 10-year risk) received a Class III recommendation meaning that the procedure was felt not to be useful/effective and provided no benefit. In contrast, the Society for Heart Attack Prevention and Eradication (SHAPE) calls for screening of all adults middle-aged and older who have CAD risk factors, a family history of CAD or have diabetes. Based primarily on the SHAPE recommendation, the state of Texas passed a new law mandating insurance coverage for imaging tests used for cardiovascular disease screening. This legislation mandates insurance coverage of up to $200 for CAC scanning or carotid intima-media thickness (CIMT) testing every 5 years for men aged between 45 and 75 years and women aged between 55 and 75 years who have diabetes or an intermediate or high Framingham Risk Score.2 Some have felt that this legislation was premature since hard evidence was lacking that such screening impacted clinical outcomes. …