Review finds “no consistent or reproducible treatment effect” for serial calcium scans

There is no evidence to support annual coronary artery calcium (CAC) screening to measure atherosclerosis progression, according to a systematic review in Archives of Internal Medicine by Peter McCullough and Kavitha Chinnaiyan. Further, an accompanying editorial by Patrick O’Malley argues that “the answer to the problem of rescanning in the community… is to stop the current practice of initial screening first.”

McCullough and Chinnaiyan identified 10 trials with serial CAC scanning including 2612 patients with either cardiovascular disease or chronic kidney disease and found “no consistent or reproducible treatment effect of any therapy.”

They note that “there is considerable interest in noninvasive measures of coronary atherosclerosis that can be used to test therapies and act as surrogates for clinically meaningful end points such as quality of life, myocardial infarction, cardiovascular death, and all-cause mortality. Our analysis of the progression of CAC suggests that this variable is not a reliable surrogate.”

After observing that “therapies aiming to reduce the overall CAC score have not been successful in the short term, and there appears to be no meaningful translation into hard clinical events,” the authors raise a note of concern “because several clinical trials are planned and under way that use the change in CAC score as an end point.”

In his editorial, O’Malley expresses considerable skepticism about even initial CAC screening, noting that it has not been shown to improve outcomes and that the so-called “motivational effect” has not been demonstrated. In addition, “there is potential harm due to radiation exposure, incidental findings, unnecessary induced interventions (sometimes invasive), insurability, quality-of-life decrements associated with labeling and medicalization of asymptomatic populations, and cost.”

O’Malley argues that “patients cannot possibly be expected to understand the appropriateness of screening, when it might be beneficial to them, and how it would affect medical decision making. Yet, that is exactly what is happening in the community with self-referral centers that directly advertise to consumers. There are members of our own profession who are not only endorsing this practice but also profiting from it.”

O’Malley advocates strong measures to prevent the continued spread of CAC screening:

“Since it seems that the medical community is unwilling to self-regulate in this probably enormously wasteful endeavor, it will require policy makers to be more forceful in reining in the madness, whether it be the Food and Drug Administration or financiers of health care. To be fair, there are strong logic, rationale, and even promise for this technology, but any further resources invested in this area should first go to large randomized clinical trials to prove its clinical impact.”


  1. Chagai Dubrawsky says

    The value of Calcium CAT Scans,is the same as Bone
    Density in Osteoporosi(Pts. who take Biphophonates).
    In both cases it tells you that it means that there is calcium in either location.What does it means?Who knows,
    As long as an anatomic finding does not correlate with
    the physiologic value,it just remain a finding.


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