Search

Background: Despite extensive use in practice, the impact of noninvasive cardiovascular imaging in primary prevention remains unclear., Methods: We searched for randomized trials that compared imaging with usual care and reported any of the following outcomes in a primary prevention setting: medication prescribing, lifestyle modification (including diet, exercise, or smoking cessation), angiography, or revascularization., Results: Seven trials were included. Trials screened patients for inducible myocardial ischemia (2 trials), coronary calcification (3 trials), carotid atherosclerosis (1 trial), or left ventricular hypertrophy (1 trial). Imaging had no effect on medication prescribing overall (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.76-1.33) or on provision of lipid-modifying agents (OR, 1.08; 95% CI, 0.58-2.01), antihypertensive drugs (OR, 1.05; 95% CI, 0.75-1.47), or antiplatelet agents (OR, 1.05; 95% CI, 0.84-1.32). Similarly, no effect was seen on dietary improvement (OR, 0.78; 95% CI, 0.22-2.85), physical activity (0.02 vs -0.08 point change for imaging vs control on a 5-point scale; P = .23), or smoking cessation (OR, 2.24; 95% CI, 0.97-5.19). Imaging was not associated with invasive angiography (OR, 1.26; 95% CI, 0.89-1.79)., Conclusions: We found limited evidence suggesting that noninvasive cardiovascular imaging alters primary prevention efforts. However, given the imprecision of these results, further high-quality studies are needed.

Objective: Cardiovascular disease (CVD) is largely preventable through appropriate risk-factor modification. We sought to compare effects of comprehensive cardiac risk factor screening with and without computed tomography (CT) imaging of the coronary arteries on behavior change related to cardiac risk in postmenopausal women., Study Design and Setting: 56 postmenopausal women were randomized to alternative screening programs and followed for 1 year., Results: Subjects randomized (n=26) to the CT imaging group were shown images of their coronary arteries and received an interpretation from a radiologist. Most subjects in the CT group had a very low-risk (73.1%) coronary calcification score at baseline. Systolic blood pressure, total cholesterol, triglyceride, LDL, and cholesterol/HDL ratio declined significantly in the conventional screening group, but not in the CT imaging group (P<0.05). As compared to baseline values, study participation lead to significant reductions in total cholesterol, HDL, LDL, and blood pressure at 6 months (P<0.05) and triglyceride (P<0.05) at 12 months., Conclusions: CVD risk-screening programs can facilitate cardiac risk reduction in women, but these data do not support an independent benefit of coronary CT imaging in a low-to-moderate risk group. The possibility of a deleterious effect of imaging on patient commitment to lifestyle changes is suggested.