title: Influence of noninvasive cardiovascular imaging in primary prevention: systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Despite extensive use in practice, the impact of noninvasive cardiovascular imaging in primary prevention remains unclear.
  
  
  METHODS
  We searched for randomized trials that compared imaging with usual care and reported any of the following outcomes in a primary prevention setting: medication prescribing, lifestyle modification (including diet, exercise, or smoking cessation), angiography, or revascularization.
  
  
  RESULTS
  Seven trials were included. Trials screened patients for inducible myocardial ischemia (2 trials), coronary calcification (3 trials), carotid atherosclerosis (1 trial), or left ventricular hypertrophy (1 trial). Imaging had no effect on medication prescribing overall (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.76-1.33) or on provision of lipid-modifying agents (OR, 1.08; 95% CI, 0.58-2.01), antihypertensive drugs (OR, 1.05; 95% CI, 0.75-1.47), or antiplatelet agents (OR, 1.05; 95% CI, 0.84-1.32). Similarly, no effect was seen on dietary improvement (OR, 0.78; 95% CI, 0.22-2.85), physical activity (0.02 vs -0.08 point change for imaging vs control on a 5-point scale; P = .23), or smoking cessation (OR, 2.24; 95% CI, 0.97-5.19). Imaging was not associated with invasive angiography (OR, 1.26; 95% CI, 0.89-1.79).
  
  
  CONCLUSIONS
  We found limited evidence suggesting that noninvasive cardiovascular imaging alters primary prevention efforts. However, given the imprecision of these results, further high-quality studies are needed.
authors.affiliation: Department of Medicine, University of Western Ontario, London, ON, Canada. dhackam@uwo.ca
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.forename: Kaveh G
authors.initials: KG
authors.lastname: Shojania
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: George K
authors.initials: GK
authors.lastname: Dresser
authors.forename: Aashish
authors.initials: A
authors.lastname: Goela
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Valentine Y
authors.initials: VY
authors.lastname: Njike
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D017023:Coronary Angiography; D003952:Diagnostic Imaging; D006801:Humans; D008019:Life Style; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors