Implications of Recent Clinical Trials in Cardiovascular Imaging on Primary Prevention Therapies
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NOVEL AND EMERGING RISK FACTORS (K. NASIR, SECTION EDITOR)
Implications of Recent Clinical Trials in Cardiovascular Imaging on Primary Prevention Therapies Vikram Agarwal 1 & Leslee J. Shaw 2 & Dan Berman 3 & Khurram Nasir 4 & Alan Rozanski 5 & Ron Blankstein 6
Published online: 2 June 2017 # Springer Science+Business Media New York 2017
Abstract Purpose of Review This review aims to provide an overview of how cardiovascular imaging can help individualize preventive cardiovascular care, while focusing on the implications of various recent noninvasive and invasive imaging studies for the field of preventive cardiology. Recent Findings Coronary artery calcium (CAC) has established itself as a well-validated tool for detecting the presence or absence of coronary atherosclerosis and thus can provide a more precise measurement of risk than many commonly used risk scores. While individuals with no CAC have
This article is part of the Topical Collection on Novel and Emerging Risk Factors * Ron Blankstein [email protected] 1
Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
2
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
3
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
4
Center for Healthcare Advancement and Outcomes, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
5
Division of Cardiology, Mt Sinai St Luke’s, Roosevelt Hospitals, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
6
Division of Cardiovascular Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
an excellent prognosis, those with even minimal CAC have an increased risk of adverse cardiovascular outcomes. These findings have now been extended across several different patient cohorts, including younger patients (e.g., age 35– 46 years), for whom the presence of any plaque is associated with a substantially higher risk. Aside from helping to guide the need for various preventive therapies, the detection of CAC may lead to improved risk factor modifications and enhance patient compliance. The implications of these studies include the fact that the incidental identification of CAC on nongated chest CT scans in patients without prior known CAD should prompt intensification of preventive therapies. Recent trials have suggested that among patients with stable symptoms, coronary CTA, as compared to functional testing, leads to higher initiation and intensification of preventive strategies, and a lower incidence of future myocardial infarction. As such, it imperative to use the results of cardiovascular imaging tests—which are often ordered to evaluate symptoms, and not necessarily for implementing preventive therapies—in a way that would promote more aggressive preventive therapies to individuals who have evidence of subclinical atherosclerotic cardiovascular disease. Summary Cardiovascular imaging in both asy
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