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Cited by 181Cardiac Imaging and DiagnosticsHealth Promotion and Cardiovascular PreventionCardiac Health and Mental Health

The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies

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Gupta, Ankur, Lau, Emily, Varshney, Ravi, Hulten, Edward A., Cheezum, Michael, Bittencourt, Marcio S., Blaha, Michael J., Wong, Nathan D. +5 more·2017·JACC: Cardiovascular Imaging
DOI 10.1016/j.jcmg.2017.01.030PMC PMC5761651
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Abstract

Objectives The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography. Background Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies. Methods We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model. Results After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure-lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure-lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors. Conclusions This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease.

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  • Showing patients their coronary calcium provides a teachable moment to empower informed decisions and improve long-term compliance for preventative therapy and lifestyle changes including smoking cessation.

    “Additionally, showing patients their coronary calcium provides a “teachable moment” to empower them to make informed, individualized decisions, and to improve long-term compliance for preventative therapy and lifestyle changes including smoking cessation11,12.”

    From Deep convolutional neural networks to predict cardiovascular risk from computed tomography (2021) · cites this paper as [12]

    The Results (Characteristics of Included Studies; page not provided) say some studies showed patients their CAC images while explaining their heart-disease risk. The Results (Lifestyle Interventions and Continuation of Preventive Pharmacological Therapy; pages not provided) report greater exercise and dietary change and greater continuation of lipid-lowering medication with nonzero CAC, but no significant effect on smoking cessation. The paper does not establish that showing images itself improved long-term compliance or empowered individualized decisions. (LLM, conf=0.88)

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Research works printed but not linked: 24

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Authors
Gupta, A., Lau, E., Varshney, R., Hulten, E. A., Cheezum, M., Bittencourt, M. S., Blaha, M. J., Wong, N. D., Blumenthal, R. S., Budoff, M. J., Umscheid, C. A., Nasir, K., & Blankstein, R.
Affiliations
  • Brigham and Women's Hospital (US)
  • Johns Hopkins University (US)
  • University of California, Irvine (US)
  • University of California, Los Angeles (US)
  • University of Pennsylvania Health System (US)
Corresponding author
Blankstein, Ron
ORCID
Venue
JACC: Cardiovascular Imaging
Publisher
Elsevier BV
Published
2017-08
Volume
10
Issue
8
Pages
833-842
ISSN
  • 1876-7591 (ISSN-L)
  • 1936-878X
DOI
10.1016/j.jcmg.2017.01.030
PMC
PMC5761651
OpenAlex
W2744593153
Cited by
181
References
0
Citations by year
2026: 17 · 2025: 18 · 2024: 17 · 2023: 18 · 2022: 22 · 2021: 25 · 2020: 20 · 2019: 23 · 2018: 15 · 2017: 5 · 2016: 1
FWCI
12.82
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC. Cardiovascular imaging (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Heart, Lung, and Blood Institute (T32HL094301)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
coronary artery calcium score, calcified coronary plaque, cardiovascular disease prevention, lipid-lowering therapy, blood pressure medication, lifestyle intervention, physical activity, dietary change
MeSH terms
Adult, Attitude of Health Personnel, Cardiovascular Agents, Coronary Artery Disease, Coronary Vessels, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Compliance, Predictive Value of Tests, Risk Factors, Time Factors, Chi-Square Distribution, Linear Models, Odds Ratio, Treatment Outcome, Coronary Angiography, Risk Reduction Behavior, Plaque, Atherosclerotic, Vascular Calcification, Protective Factors

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