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Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review
Journal of General Internal Medicine, 09/09/2011
Evidence Based Medicine
Rodondi N et al. - Available evidence about atherosclerosis screening is limited, with mixed results on cardiovascular risk factors (CVRF) control, increased smoking cessation in one randomized controlled trials (RCT), and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.
Methods- This study is a systematic review.
- The authors searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions.
- The authors included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease.
- The authors identified four randomized controlled trials (RCT, n=709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n=2,994).
- In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p=0.03) in one RCT.
- Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk.
- However, such data were conflicting and limited by the lack of a randomized control group.
- No studies examined the impact of screening on cardiovascular events or mortality.
- Heterogeneity in screening methods and studied outcomes did not permit pooling of results.