Cardiac CT Associated With Enhanced Preventative Medical Care

MedicalResearch.com Interview with:
Eddie Hulten, MD MPH FACC FSCCT
Eddie Hulten, MD MPH FACC FSCCT
and

Ron Blankstein, MD FACC Ron Blankstein, MD FACC
Cardiovascular Imaging Noninvasive Cardiovascular Imaging
Walter Reed National Military Medical Center Brigham and Women’s Hospital
Bethesda, MD Boston, MA

MedicalResearch: What are the main findings of the study?

Answer: Although any medical test should be used to change management, the extent to which CCTA (Cardiac computed tomography angiography) findings are associated with medication changes (aspirin and lipid lowering) is not previously extensively studied.

Thus, we conducted the largest and one of the longest follow up studies of preventive cardiovascular medications before and after coronary computed tomography angiography (CCTA). We demonstrated that CCTA findings are associated with significant changes in preventive medications after CCTA.

MedicalResearch: Were any of the findings unexpected?

Answer: We also showed for the first time in a hypothesis generating analysis, that intensification of statin therapy after CCTA is associated with reduced hazard for future adverse cardiovascular events among patients with extensive (defined as > 4 coronary segments), non-obstructive coronary artery disease (CAD).

MedicalResearch: What should clinicians and patients take away from your report?

Answer: Among patients without known prior Coronary Artery Disease (CAD), CCTA can powerfully triage patients to very low risk (no CAD by CCTA), minimally increased risk (non-obstructive CAD), and higher risk patients (extensive, non-obstructive CAD and obstructive CAD). Understanding the prognostic importance of CCTA findings can help guide preventive medical therapy. Although patients with non-obstructive CAD have not traditionally been a focus of preventive medical therapy, such patients with extensive CAD may warrant more aggressive preventive medical management, although this finding should be replicated in prospective, randomized trials.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: Additional study of preventive medical therapy after CCTA is warranted, in particular prospective trials of medication intensification for patients with extensive, non-obstructive CAD.

Citation:

Coronary Artery Disease Detected by Coronary CT Angiography Is Associated with Intensification of Preventive Medical Therapy and Lower LDL Cholesterol

Edward Hulten, Marcio Sommer Bittencourt, Avinainder Singh, Daniel O’Leary, Mitalee P. Christman, Wafa Osmani, Suhny Abbara, Michael Steigner, Quynh A. Truong, Khurram Nasir, Frank Rybicki, Josh Klein, Jon Hainer, Thomas J. Brady, Udo Hoffmann, Brian Ghoshhajra, Rory Hachamovitch, Marcelo F. Di Carli, and Ron Blankstein

Circ Cardiovasc Imaging. 2014;CIRCIMAGING.113.001564published online before print June 6 2014, doi:10.1161/CIRCIMAGING.113.001564