Dallas Heart Study: calcium screening adds little to traditional risk factors

Calcium screening provides very little additional prognostic information beyond traditional risk factors, according to a study by Mahesh Patel et al in the American Heart Journal. As part of the Dallas Heart Study, 2,610 patients between 30 and 65 years underwent calcium screening in addition to traditional Framingham risk scoring.

In moderately high risk patients, for whom calcium screening has most often been proposed,  the investigators found no additional benefit in women and found only a “minor impact” in men. These findings were not substantially altered by either changing the age cut-offs or moving to a lower calcium threshold.

The investigators did find that calcium screening in otherwise low risk patients was capable of identifying some patients at higher risk than might have otherwise been thought. “However,” as the investigators note, “given the large size of the LR [low risk] population, screening for CAC in this entire group is clearly not feasible and not advocated.”

Lead investigator Amit Khera told CardioBrief that “what may seem like a logical screening strategy may actually not work all that well in terms of efficiency when applied in practice.  When we are considering the costs of screening a large proportion of the population as well as the radiation risk and incidental findings, we need to be quite sure of what we can expect to find v. the potential benefits.”

Comments

  1. “In moderately high risk patients, for whom calcium screening has most often been proposed”

    Wong wrong wrong!

    Per ACC/AHA guidelines, calcium scoring has been proposed for low to intermediate Framingham risk patients, not moderately to high risk. There would be little prognostic benefit in this group as the event rate is high regardless.

    Nothing much to report then…

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