title: Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review.
abstract: BACKGROUND
  Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized.
  
  
  OBJECTIVE
  We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes.
  
  
  METHODS
  This study is a systematic review.
  
  
  METHODS
  We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.
authors: Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland. Nicolas.Rodondi@insel.ch
authors: Nicolas
authors: N
authors: Rodondi
authors: Reto
authors: R
authors: Auer
authors: Vanessa
authors: V
authors: de Bosset Sulzer
authors: William A
authors: WA
authors: Ghali
authors: Jacques
authors: J
authors: Cornuz
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods