title: Primary Prevention of CVD: The Role of Imaging Trials.
abstract: The optimal approach for screening for cardiovascular disease remains controversial. A new standard of "therapeutic efficacy" requires that screening tests which involve cardiac imaging not only predict events but also improve clinical outcomes compared with usual care. To date, 5 prospective randomized trials have been conducted to compare outcomes based on imaging-guided screening and prevention versus assignment to usual care in screening populations. One trial involved cardiac stress imaging, 3 involved coronary artery calcium scanning, and 1 involved coronary computed tomography angiography. Due to the current very low event risk in asymptomatic populations, these trials have been substantially underpowered to assess the impact of imaging-guided prevention on hard cardiac events. This review derives lessons learned from these trials relative to the future design of imaging-based screening trials, including analysis regarding the optimal methods for screening, and what are the relevant clinical outcomes to assess the efficacy of imaging-based screening for prevention.
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: alan.rozanski@mountsinai.org.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.affiliation: Intermountain Medical Center Heart Institute, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Medical Center and the Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D019540:Area Under Curve; D057791:Cardiac Imaging Techniques; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002986:Clinical Trials as Topic / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D053208:Kaplan-Meier Estimate; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods*; D065840:Protective Factors; D012372:ROC Curve; D015203:Reproducibility of Results; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: atherosclerosis; cardiovascular disease; coronary artery calcium; screening