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Calcium Scan Improves Heart Risk Prediction
Date:4/27/2010

ce an adverse event.

But does that added predictive power make a difference in terms of saving lives and reducing unnecessary treatment?

"We didn't look at that," Greenland said. "What we can say here is that additional testing looks like it improves prediction. Whether it improves clinical outcome requires a different kind of study."

The first steps toward such a study have been taken. "We are in discussions with the National Heart, Lung, and Blood Institute and have been encouraged to submit a proposal," Greenland said.

Such a study might involve tens of thousands of participants and cost over $100 million, said Dr. Andrew J. Einstein, director of cardiac computed tomography research at Columbia University Medical Center in New York City.

The study would aim at determining whether more intensive treatment of traditional risk factors would improve survival of people classified as high-risk by the coronary artery calcium score. "No study has compared patients who had intensive preventive therapy with those who didn't and see if it makes a difference in terms of the number of heart attacks people have," Einstein said. "That study would be the ideal."

Such a trial needn't be as expensive as Einstein estimates, Greenland said. He puts the cost at "between $29 million and $50 million" and notes that the U.S. Institute of Medicine lists that kind of trial among the top 100 that should be done using funds provided for comparative effectiveness research in the newly approved health care program.

Cancer risk and cost are also parts of the equation. A well-controlled computed tomography scan gives about twice the radiation exposure as a mammogram, Greenland said. A new large-scale trial could show whether the added risk is justified by the number of lives saved, and the same is true of the cost, estimated to run between $200 and $600 per scan.

"Concern about radiation for any individual is minima
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