title: Comparison of coronary calcium screening versus broad statin therapy for patients at intermediate cardiovascular risk.
abstract: Net reclassification has become widely accepted as a method to demonstrate whether new diagnostic technologies add significantly to the discrimination of risk. However, more accurate categorization of risk does not necessarily result in a better clinical outcome. This study examined whether coronary artery calcium, a technology that improves net reclassification in patients at intermediate risk for cardiovascular events, is superior to a strategy that calls for broader intervention with statin therapy in these patients. To do so, the clinical impact and costs of 2 intervention regimens on outcome in the Multi-Ethnic Study of Atherosclerosis (MESA) were calculated based on the known efficacy of statins. Intervention 1 involved treatment of all subjects at conventional intermediate risk with moderate-dose stain, whereas intervention 2 involved moderate- and high-dose statin therapy, respectively, of those remaining at intermediate risk and those reassigned to high risk after reclassification by coronary artery calcium. The 2 strategies would decrease clinical events by 23% and would produce net savings. However, these would be greater with the broad statin prevention strategy than with the coronary calcium reclassification strategy ($732,152 vs $288,336, respectively). In conclusion, even in the short term, the broad statin prevention strategy would be at least as effective in decreasing clinical events but with greater net savings than a prevention strategy using coronary calcium screening.
authors.affiliation: Division of Cardiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada. allansniderman@hotmail.com
authors.forename: Allan D
authors.initials: AD
authors.lastname: Sniderman
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Lawler
authors.forename: Ken
authors.initials: K
authors.lastname: Williams
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
mesh_terms: D000368:Aged; D002118:Calcium / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000191:economics / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003331:Coronary Vessels / Q000737:chemistry*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002118:Calcium