Comparative Effectiveness and Cost-Effectiveness of Computed Tomography Screening for Coronary Artery Calcium in Asymptomatic Individuals

Kempen, Bob J.H. van; Spronk, Sandra; Koller, Michael; Elias‐Smale, Suzette; Fleischmann, Kirsten E.; Ikram, M. Arfan; Krestin, Gabriël P.; Hofman, Albert; Witteman, Jacqueline C. M.; Hunink, M. G. Myriam

doi:10.1016/j.jacc.2011.05.056

Cited by 70 publications

(44 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…15 The clinical relevance and whether a strategy including CT examinations is cost-effective are yet to be explored. 34 However, for CAC this improvement in prediction of cardiovascular outcomes (including mortality) has previously been established, [35][36][37] and has become the basis for trials on its use as screening tool for cardiovascular disease. 38 We found that AAC might represent a better reflection an individual's total burden of atherosclerosis, and that it further improved the performance of a prediction model for mortality, which already included CAC.…”

Section: Downloaded Frommentioning

confidence: 99%

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Bos

Leening

Kavousi

et al. 2015

Circ: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

Background— Atherosclerosis is a major contributor to global morbidity and mortality. Although atherosclerosis is a systemic disease, its burden varies considerably across vessel beds, which may translate into differences in mortality risk. Methods and Results— From 2003 to 2006, a sample of 2408 elderly participants (mean age, 69.6±6.7 years; 52.4% female) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. Mortality follow-up was complete until January 1, 2012. We investigated associations of calcification in each vessel bed with mortality using Cox regression, adjusting for age, sex, and cardiovascular risk factors. Next, all vessel beds were included into 1 model to investigate independency of associations. Finally, we investigated the predictive value of calcification beyond the predictors included in the Pooled Cohort equations. During 15 775 person-years of follow-up, 283 participants died. Larger calcification volumes in all vessels were related to higher risks of all-cause mortality, cardiovascular, and noncardiovascular mortality, independent of cardiovascular risk factors. Most prominent associations were found for aortic arch calcification and cardiovascular mortality (age- and sex-adjusted hazard ratio per 1-SD increase 2.72 [95% confidence interval, 1.85–4.02]), independent of calcification elsewhere (hazard ratio, 1.75 (95% confidence interval, 1.13–2.72]). Calcification in any vessel improved prediction for all 3 outcomes. Conclusions— Atherosclerotic load in major vessel beds is associated with an increased risk of death. In particular, aortic arch calcification volume yields unique information with regard to mortality in addition to atherosclerosis in other vessel beds.

show abstract

Section: Downloaded Frommentioning

confidence: 99%

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Bos

Leening

Kavousi

et al. 2015

Circ: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…The report in this issue of the Journal by van Kempen et al (9) addresses the role of CAC testing in asymptomatic individuals with cost-effectiveness analysis (CEA) and comparative effectiveness analysis. Its primary conclusion is that screening for CAC with CT in individuals at intermediate risk of CHD is probably cost-effective in men but is unlikely to be cost-effective in women.…”

Section: See Page 1690mentioning

confidence: 99%

“…As a result, CAC testing could become less valuable in selecting patients for statin treatment and improving clinical outcomes. All of these scenarios lead to the conclusion that additional information beyond that available from the CEA by van Kempen et al (9) might be needed, before a convincing and definitive change in clinical practice guidelines would be justified.…”

Section: See Page 1690mentioning

confidence: 99%

“…This "treat all" approach emerged as the dominant strategy in some of the sensitivity analyses by van Kempen et al (9), yet with different assumptions in place CAC testing was the "winning" approach.…”

Section: See Page 1690mentioning

confidence: 99%

“…Others have also advocated for such a trial (16,17). Judging from the very similar results for the strategies compared in the van Kempen et al (9) costeffectiveness analysis, it is obvious that such a trial would need to enroll a large number of patients who were followed for at least 4 to 5 years. The study would be challenging logistically as well as costly.…”

Section: See Page 1690mentioning

confidence: 99%

See 2 more Smart Citations

Time for a Policy Change for Coronary Artery Calcium Testing in Asymptomatic People?

Greenland

Polonsky

2011

Journal of the American College of Cardiology

View full text Add to dashboard Cite

show abstract

Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death

et al. 2017

View full text Add to dashboard Cite

IMPORTANCE Coronary artery calcium (CAC) is associated with coronary heart disease (CHD) and cardiovascular disease (CVD); however, prognostic data on CAC are limited in younger adults. OBJECTIVE To determine if CAC in adults aged 32 to 46 years is associated with incident clinical CHD, CVD, and all-cause mortality during 12.5 years of follow-up. DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective community-based study that recruited 5115 black and white participants aged 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n = 3043), 20 (n = 3141), and 25 (n = 3189) years after recruitment. The mean follow-up period for incident events was 12.5 years, from the year 15 computed tomographic scan through August 31, 2014. MAIN OUTCOMES AND MEASURES Incident CHD included fatal or nonfatal myocardial infarction, acute coronary syndrome without myocardial infarction, coronary revascularization, or CHD death. Incident CVD included CHD, stroke, heart failure, and peripheral arterial disease. Death included all causes. The probability of developing CAC by age 32 to 56 years was estimated using clinical risk factors measured 7 years apart between ages 18 and 38 years. RESULTS At year 15 of the study among 3043 participants (mean [SD] age, 40.3 [3.6] years; 1383 men and 1660 women), 309 individuals (10.2%) had CAC, with a geometric mean Agatston score of 21.6 (interquartile range, 17.3–26.8). Participants were followed up for 12.5 years, with 57 incident CHD events and 108 incident CVD events observed. After adjusting for demographics, risk factors, and treatments, those with any CAC experienced a 5-fold increase in CHD events (hazard ratio [HR], 5.0; 95% CI, 2.8–8.7) and 3-fold increase in CVD events (HR, 3.0; 95% CI, 1.9–4.7). Within CAC score strata of 1–19, 20–99, and 100 or more, the HRs for CHD were 2.6 (95% CI, 1.0–5.7), 5.8 (95% CI, 2.6–12.1), and 9.8 (95% CI, 4.5–20.5), respectively. A CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants (HR, 3.7; 95% CI, 1.5–10.0); of the 13 deaths in participants with a CAC score of 100 or more, 10 were adjudicated as CHD events. Risk factors for CVD in early adult life identified those above the median risk for developing CAC and, if applied, in a selective CAC screening strategy could reduce the number of people screened for CAC by 50% and the number imaged needed to find 1 person with CAC from 3.5 to 2.2. CONCLUSIONS AND RELEVANCE The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death. Selective use of screening for CAC might be considered in individuals with risk factors in ea...

show abstract

Comparative Effectiveness and Cost-Effectiveness of Computed Tomography Screening for Coronary Artery Calcium in Asymptomatic Individuals

Abstract: Screening for coronary artery calcium with CT in individuals at intermediate risk of CHD is probably cost-effective in men but is unlikely to be cost-effective in women.

Cited by 70 publications

References 58 publications

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Time for a Policy Change for Coronary Artery Calcium Testing in Asymptomatic People?

Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death

Contact Info

Product

Resources

About