Primary Prevention of CVD: The Role of Imaging Trials

JACC Cardiovasc Imaging. 2017 Mar;10(3):304-317. doi: 10.1016/j.jcmg.2017.01.009.

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.

Keywords: atherosclerosis; cardiovascular disease; coronary artery calcium; screening.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Area Under Curve
  • Cardiac Imaging Techniques*
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Clinical Trials as Topic / methods*
  • Evidence-Based Medicine
  • Humans
  • Kaplan-Meier Estimate
  • Predictive Value of Tests
  • Primary Prevention / methods*
  • Protective Factors
  • ROC Curve
  • Reproducibility of Results
  • Research Design*
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome