Author + information
- Received May 19, 2020
- Revision received June 22, 2020
- Accepted June 26, 2020
- Published online September 16, 2020.
- Philip Greenland, MDa,b,∗ (, )
- Erin D. Michos, MD, MHSc,
- Nicole Redmond, MD, PhD, MPHd,
- Lawrence J. Fine, MD, DrPHd,
- Karen P. Alexander, MDe,
- Walter T. Ambrosius, PhDf,
- Kirsten Bibbins-Domingo, PhD, MD, MASg,
- Michael J. Blaha, MD, MPHh,
- Ron Blankstein, MDi,
- Stephen P. Fortmann, MDj,
- Amit Khera, MDk,
- Donald M. Lloyd-Jones, MD, ScMa,b,
- David J. Maron, MDl,
- James K. Min, MDm,
- J. Brent Muhlestein, MDn,
- Khurram Nasir, MD, MPHo,
- Madeline R. Sterling, MD, MPH, MSp and
- George Thanassoulis, MD, MScq
- aDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- bDepartment of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois
- cDepartment of Medicine (Cardiology), Johns Hopkins School of Medicine, Baltimore, Maryland
- dNational Heart, Lung, and Blood Institute, Bethesda, Maryland
- eDepartment of Medicine (Cardiology), Duke University Medical Center, Durham, North Carolina
- fDepartment of Biostatistics and Data Science in the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- gDepartment of Epidemiology & Biostatistics, University of California-San Francisco (UCSF) School of Medicine, San Francisco, California
- hDepartment of Medicine (Cardiovascular and Clinical Epidemiology), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
- iDepartment of Medicine (Cardiovascular), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- jKaiser Permanente Center for Health Research, Portland, Oregon
- kDepartment of Internal Medicine (Cardiology), University of Texas-Southwestern Medical Center, Dallas, Texas
- lDepartment of Medicine (Cardiovascular Medicine), Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
- mCleerly, Inc., New York, New York
- nDepartment of Internal Medicine (Cardiovascular Medicine), Intermountain Health Care and University of Utah School of Medicine, Salt Lake City, Utah
- oCenter for Outcomes Research, Methodist Hospital and Baylor School of Medicine, Houston, Texas
- pDepartment of Internal Medicine, Weill Cornell Medical College, New York, New York
- qDepartment of Medicine (Division of Experimental Medicine), McGill University Health Center, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Philip Greenland, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Suite 1400, 680 North Lake Shore Drive, Chicago, Illinois 60611.
• CAC measurement is considered useful for enhancing risk assessment in primary prevention, but trial evidence is limited.
• An NHLBI-sponsored workshop in 2019 reviewed available evidence and current trials and made recommendations for possible future trials across the lifespan.
• Trials currently underway in middle-age adults are likely to be sufficient.
• Trials in younger and older adults were recommended, as were trials leveraging existing trials, real-world data streams, and opportunistic screening.
Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the primary prevention setting. Clinical trials are under consideration. The National Heart, Lung, and Blood Institute convened a multidisciplinary working group on August 26 to 27, 2019, in Bethesda, Maryland, to review available evidence and consider the appropriateness of conducting further research on coronary artery calcium (CAC) testing, or other coronary imaging studies, as a way of informing decisions for primary preventive treatments for cardiovascular disease. The working group concluded that additional evidence to support current guideline recommendations for use of CAC in middle-age adults is very likely to come from currently ongoing trials in that age group, and a new trial is not likely to be timely or cost effective. The current trials will not, however, address the role of CAC testing in younger adults or older adults, who are also not addressed in existing guidelines, nor will existing trials address the potential benefit of an opportunistic screening strategy made feasible by the application of artificial intelligence. Innovative trial designs for testing the value of CAC across the lifespan were strongly considered and represent important opportunities for additional research, particularly those that leverage existing trials or other real-world data streams including clinical computed tomography scans. Sex and racial/ethnic disparities in cardiovascular disease morbidity and mortality, and inclusion of diverse participants in future CAC trials, particularly those based in the United States, would enhance the potential impact of these studies.
Dr. Bibbins-Domingo was a member and chair of the U.S. Preventive Services Task Force from 2010 to 2017. Dr. Blaha has received funding from the Food and Drug Administration, National Heart, Lung, and Blood Institute, Aetna Foundation, and Amgen Foundation; and has served on the advisory board (honoraria) for Amgen, Sanofi, Regeneron, Novartis, Novo Nordisk, Bayer, and Akcea (all significant except Akcea, modest). Dr. Blankstein has received funding from Amgen Inc. and Astellas Inc.; has served as President of the Society of Cardiovascular Computed Tomography; and is on Board of Directors of the American Society of Preventive Cardiology. Dr. Min has equity in Cleerly; and has served on advisory boards for Arineta and GE Healthcare. Dr. Nasir is supported by the Jerold B. Katz Academy of Translational Research. Dr. Sterling has received funding from the National Heart, Lung, and Blood Institute. Dr. Thanassoulis has received funding from Fonds de Recherche Québec – Santé, Doggone Foundation; has received honoraria/personal fees (advisory boards/speaker fees) from Amgen, Sanofi/Regeneron Pharmaceuticals, HLS Therapeutics, and Boehringer Ingelheim; and has received grants from Ionis Pharmaceuticals and Servier Laboratories outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The views expressed in this paper are those of the authors and do not represent the official position of the National Institutes of Health, the National Heart, Lung, and Blood Institute, or the U.S. Government. This paper reflects the proceedings of this National Heart, Lung, and Blood Institute workshop and does not represent an official position of the U.S. Preventive Services Task Force.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received May 19, 2020.
- Revision received June 22, 2020.
- Accepted June 26, 2020.
- 2020 American College of Cardiology Foundation
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