Abnormal Coronary Artery Calcium Scans in Asymptomatic Patients

Eaton, R. Philip; Burge, Mark R.; Comerci, George D.; Cavanaugh, Brendan; Ramo, Barry W.; Schade, David S.

doi:10.1016/j.amjmed.2016.10.006

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…Physicians will be faced with increasing numbers of asymptomatic individuals who have had CAC testing [ 3 , 63 , 64 ]. When this score is positive, patients are often concerned about their risk of having a cardiovascular event.…”

Section: Discussionmentioning

confidence: 99%

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Management of Asymptomatic Patients With Positive Coronary Artery Calcium Scans

Burge

Eaton

Comerci

et al. 2017

Journal of the Endocrine Society

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Background:The widespread availability of the coronary artery calcium scan to diagnose coronary artery atheroma semiquantitatively and its prognostic significance has frequently resulted in a difficult therapeutic decision for physicians caring for asymptomatic patients.Patients and Risk Factors:Of particular concern are patients over 40 years of age and young adults characterized by multiple cardiovascular risk factors. The correct prognostic interpretation of coronary artery calcium scores and the potential benefits and risks of various therapeutic modalities need to be understood.Conclusion:This review describes the therapeutic choices available to endocrinologists and provides recommendations for various treatment options.

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Section: Discussionmentioning

confidence: 99%

“…The number of asymptomatic individuals in the high and intermediate risk categories in the United States is large and includes all diabetic patients and individuals with sufficient Framingham risk factors and/or genetic causes of hyperlipidemia. These individuals are often under the care of endocrinologists in concert with primary care physicians [ 3 ].…”

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confidence: 99%

Management of Asymptomatic Patients With Positive Coronary Artery Calcium Scans

Burge

Eaton

Comerci

et al. 2017

Journal of the Endocrine Society

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“…This approach requires testing asymptomatic individuals for heart disease before they have a heart attack or stroke [63] (Figure 3). In reality, The arguments for using one LDLc goal for all individuals at increased risks have previously been made [64].…”

Section: A Simplified Approach-the Goal Of Prevention Is To Identify mentioning

confidence: 99%

The Rationale for a Different Approach to Preventing Cardiovascular Disease

Schade¹,

Ramo²,

Obenshain³

et al. 2019

WJCD

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The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years and has now reached epidemic status. Since the year 2000, approximately 600,000 heart attacks and ASCVD related deaths have occurred annually in the United States. It is the most common cause of death in the U.S., more than all cancers combined. The financial costs are staggering, amounting to 555 billion dollars per year in direct and indirect costs. Outlook for an improvement in these statistics is not encouraging as the U.S. population continues to become more obese and to develop diabetes. The Question: Why is ASCVD continuing to be a major challenge to healthcare providers when the pathogenesis is known and inexpensive preventative treatment is available? The reasons are multiple and complex. First, present financial reimbursement policies of healthcare organizations reward treatment of a disease and its complications instead of preventing the disease. Second, professional guidelines and treatment goals are often too complex, subject to interpretation, and time-consuming to be useful in the clinical setting. Third, no specific follow-up of patients at risk for ASCVD is recommended when the risk assessment changes. Fourth, many expensive cardiovascular diagnostic tests are utilized without meeting appropriate guidelines for their use. Fifth, treatment of individuals without first proving the presence of disease results in poor adherence to therapy. The Solution: This article describes the rationale for a new approach to the prevention of ASCVD in asymptomatic individuals. It is based upon preventing ASCVD by identifying all asymptomatic individuals How to cite this paper:

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“…4 Despite several recent publications outlining the benefits of calcium scanning, most primary care physicians are not familiar with the interpretation of coronary artery calcium scores. 9 Referral to a cardiologist is common practice for patients with a positive calcium scan. This occurs despite the evidence that further testing is not required unless the patient is having angina at rest.…”

mentioning

confidence: 99%

“…This occurs despite the evidence that further testing is not required unless the patient is having angina at rest. 9 Additional physician training can help reduce these unnecessary referrals.…”

mentioning

confidence: 99%