OBJECTIVE We conducted a prospective randomized trial to compare the clinical impact of conventional risk factor modification to that associated with coronary artery calcium (CAC) scanning. BACKGROUND Although CAC scanning predicts cardiac events, its impact on subsequent medical management and CAD risk is not known. METHODS We assigned 2,137 volunteers to groups that did versus did not undergo CAC scanning before risk factor counseling. The primary end-point was 4-year change in CAD risk factors and Framingham Risk Score (FRS). We also compared the groups for differences in downstream medical resource utilization. RESULTS Compared to the no-scan group, the scan group showed a net favorable change in systolic blood pressure (p=0.02), LDL-cholesterol (p=0.04), waist circumference for those with increased abdominal girth (p=0.01), and tendency to weight loss among overweight subjects (p=0.07). While mean FRS rose in the no-scan group, it remained static in the scan group (0.7±5.1 versus 0.002±4.9, p=0.003). Within the scan group, increasing baseline CAC score was associated with a dose-response improvement in systolic and diastolic blood pressure (p<0.001), total cholesterol (p<0.001), LDL-cholesterol (p<0.001), triglycerides (p<0.001), weight (p<0.001) and FRS (p=0.003). Downstream medical testing and costs in the scan group were comparable versus the no-scan group, balanced by lower and higher resource utilization for those with normal CAC scans and CAC scores ≥400, respectively. CONCLUSIONS As compared to no scanning, randomization to CAC scanning was associated with superior CAD risk factor control without increasing downstream medical testing. Further study of CAC scanning for improvement of cardiovascular outcomes may be warranted. (ClinicalTrials.gov, number NCT00927693).

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Background/Objective: Individuals with spinal cord injury (SCI) have been reported to have an increased prevalence of premature cardiovascular disease. Whether the increased risk of disease is owing to clustering of traditional cardiac risk factor or is over and above that predicted by risk factors was addressed. Methods: Ninety-one persons with chronic SCI were studied for subclinical atherosclerosis. Cardiac risk factors and coronary artery calcium (CAC) was compared to matched non-SCI controls. The 273 controls were 3:1 matched for age, gender, ethnicity and risk factors and were drawn from a national database of over 30 000 asymptomatic persons undergoing coronary scanning. Results: Seventy-six men and 15 women were studied. Average age was 49.7712 years. Duration of injury was 19.7710 years. The ethnicity of the study cohort included 36% Caucasian, 49% Latino, 10% African American, and 5% other. The mean calcium score of the SCI group was significantly greater than the control group (757218 versus 287104, Po0.001). The prevalence of any CAC score was greater in the SCI population than the control population (51 versus 39%, Po0.05), as was CAC score 4100 (16 versus 7%, Po0.01). Women with SCI had a significantly lower CAC score than men (mean score: 12 versus 86, Po0.01). Conclusion: Patients with SCI were shown to have greater atherosclerotic burden than ablebodied controls. Of note, and unexplained, this finding is beyond that explained by the clustering of traditional risk factors. On the basis of these findings, increased attention should be directed toward the prevention of coronary heart disease in those with SCI.

In patients with suspected or documented heart disease, a precise quantitative and qualitative assessment of cardiac function is critical for clinical diagnosis, risk stratification, management and prognosis. Cardiac CT is increasingly being used in diagnosis of coronary artery disease. Initially multi-detector row computed tomography (MDCT) was used chiefly for detecting coronary artery stenosis and assessment of cardiac morphology. Electron beam computed tomography has been shown to provide a highly accurate ejection fraction (+/-1%), with 50 ms image acquisition per image. Retrospective electrocardiographic gating allows for image reconstruction in any phase of the cardiac cycle. Thus, end systolic and end diastolic images can be produced to assess ventricular volumes and function. Despite lower temporal resolution than electron beam computed tomography, the ability of MDCT to assess ejection fraction is preserved. In the assessment of cardiac function, MDCT has been shown to be in good agreement with echocardiography, cineventriculography, single photon emission computed tomography and magnetic resonance imaging. The fast technical development of scanner hardware along with multisegmental image reconstruction has led to rapid improvement of spatial and temporal resolution and significantly faster cardiac scans. The same data that is acquired for MDCT angiography can also be used for evaluation of cardiac function. Considering contrast media application, radiation exposure, and limited temporal resolution, MDCT solely for analysis of cardiac function parameters seems not reasonable at the present time. However, because the data is already obtained during coronary evaluation, the combination of noninvasive coronary artery imaging and assessment of cardiac function with MDCT is a suitable approach to a conclusive cardiac workup in patients with suspected coronary artery disease. MDCT seems suitable for assessment of cardiac function by MDCT when results are held in comparison to magnetic resonance imaging as the reference standard. Given the radiation dose and contrast requirement, referring a patient to MDCT only for evaluation of function is not warranted, but rather adds important clinical information to the already acquired data during retrospective triggering for MDCT angiography.

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Hypertension and inflammation promote cardiovascular disease (CVD). Even high normal systolic blood pressure (SBP) is associated with increased CVD risk. We assessed the relationship of elevated SBP within the normotensive range and white blood cell (WBC) count. This is a cross-sectional study of 3484 white asymptomatic individuals (mean age: 4378 years, 79% males) without hypertension with SBPo140 mm Hg. White blood cell count X75th percentile (8.35 Â 10 9 cells/l) was considered cutoff for elevated WBC. Subjects were classified into three levels of SBP (first: o120 mm Hg, n ¼ 1176, 34%; second: 120-129 mm Hg, n ¼ 1654, 47%; third: 130-139 mm Hg, n ¼ 654, 19%). Mean WBC count increased linearly across SBP categories (first: 6.1471.54, second: 6.2071.52, third: 6.4171.62, P ¼ 0.02 for trend). There was a linear increase in prevalence of elevated WBC across higher SBP categories (22, 24 and 28%, P ¼ 0.02). As compared to those with SBPo120 mm Hg, in multivariate linear regression analyses (adjusting for age, gender, smoking status, diabetes, body mass index, physical activity, cholesterol/ high-density lipoprotein cholesterol ratio) WBC count was significantly higher among participants with SBP 130-139 mm Hg (regression coefficient: 2.64, 95% confidence interval: 1.04-4.24, P ¼ 0.001). Odds ratio for prevalence of elevated WBC with SBPo120 mm Hg as reference group was 1.14 (0.92-1.41) for SBP 120-129 mm Hg and 1.50 (1.15-1.92) for SBP 130-139 mm Hg. In conclusion, Higher SBP within the normotensive range is also associated with elevated WBC count. Further studies are needed to clarify the role of inflammation in high normal SBP and associated CVD risk.

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