Coronary Calcium Screening and the American Heart Association News Embargo

Abstract

Coronary calcium imaging with computed tomography (CT) for the detection of coronary artery disease has emerged as one of several novel measures of cardiovascular risk. These measures, which also include C-reactive protein, homocysteine, lipoprotein-a, the ankle-brachial index, and carotid intimal-medial thickness, have been the subject of considerable interest on the part of the medical profession and the media for a number of years. Their role in the primary prevention of cardiovascular disease has not been firmly established, however, and hence the American Heart Association (AHA) has not recommended their implementation on a population-wide basis. The AHA’s current position on CT scanning for coronary calcification has been articulated in 3 statements dating from 2000.1–3 When a physician is faced with a patient at intermediate risk, selected use of coronary calcium scores may be appropriate if the results have the potential to alter the treatment of the patient. The published literature does not yet, however, clearly define whether long-term patient outcomes can be improved by modifying treatment on the basis of coronary calcium scores. Thus, which asymptomatic individuals require or will benefit from CT scanning has not yet been determined with certainty. These statements pertain equally to the other emerging measures of risk noted above. Coronary scanning with CT has received increased media attention over the past few months, perhaps in the wake of reports of cardiovascular procedures performed on noteworthy public figures. Recent reports in the lay press suggested that the AHA’s position on this subject was about to change and that the Association would endorse this technology for atherosclerosis screening in asymptomatic individuals. These reports have led to an unfortunate level of speculation by the public and the medical community, principally because the statement of imminent support is simply incorrect: The AHA does not endorse devices, equipment, or medications, …