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The calcium scan results could help guide treatment, he explained. "Applying intensified medical therapy or shortened follow-up intervals in these patients could result in a major benefit in their outcome," Hacker said.

But he quickly added that the finding "has to be verified in prospective trials."

The study does not bear on a controversy about whether calcium scans should be used to screen healthy people for heart disease, Hacker said. "As the present study focused on patients with already known disease, there can be no conclusions drawn for a screening setting," he said.

But it is also difficult to decide whether to add calcium scans to the tests normally used after heart disease is diagnosed on the basis of this study, said Dr. Thomas G. Gerber, an associate professor of medicine and radiology at the Mayo Clinic.

It was a small study, Gerber said, and selection of the people in such a study can be an issue. "They seem to have done a good job of picking patients, but we are always cautious about patient selection," he said.

And the treatment goals for managing people with known heart disease are already clear, Gerber said.

"It is difficult to know where a calcium score would tell us something that would change our management of a patient," he said. "The calcium score only shows an increased risk. It doesn't tell us how we can modify risk other than by doing what we already should be doing, which is treating known risk factors."

It's clear that measures to control risk factors such as high blood pressure and obesity should be stricter in people with more severe heart disease, Gerber said. "Nobody knows if making those measures even more strict would make the outcome better," he said. "That stands to reason, but we just don't know. No one has shown how making decisions based on calcium content influences outcome. The studies to tell us h
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