Coronary Artery Scanning vs Primary Prevention

Well, I obviously made it back safely to Las Vegas.  We moved everything out of our car and started to unpack & sort through 2 weeks worth of laundry in preparation for a marathon wash session in the morning.  I also attempted to sort through 2 weeks worth of email.  I guess I won't have to worry about snail mail until Tuesday.  Thank goodness for small favors!  However, I've got a boat load (no pun intended) of journal articles to review.

Therefore, I thought I'd start off 2012 with something easy, an edited conversation, if you will, between an academic cardiologist and his fellows regarding the current state of knowledge regarding the use of coronary artery scanning and its impact upon primary prevention, that is, prior to disease occurrence.  Remember that screening (or secondary prevention) is intended to discover disease in its early stages prior to onset of illness, while tertiary prevention is mitigating the impact of illness once it has made itself known.

With this in mind, let's turn our attention to heart disease.  Nutrition & physical activity are two excellent forms of primary prevention in youth and young adults prior to onset of intima media thickness which precedes atherosclerosis.  Carotid ultrasound can determine if you've already progressed beyond absence to occurrence.  Coronary artery scanning looks for calcification or the late stages of atherosclerosis.  The absence of excessive intima media thickness or coronary artery calcification (CAC) suggests that one may have time for nutrition & physical activity to prevent progression to heart disease.

However, as pointed out in this commentary published in the Archives of Internal Medicine, we simply don't have randomized controlled trials as evidence of this hypothesis.  Furthermore, recent studies have demonstrated that the knowledge of one's CAC score doesn't make much impact upon one's lifestyle, at least not enough to improve one's cardiac risk factors.

So take a minute and read this short 2 page essay and consider your next screening test in an asymptomatic patient.  It's not too late to resolve to live a healthier lifestyle this year.  And it doesn't require a CAC score to do so!

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