March 24, 2012 (Chicago, Illinois) — Patients with severe coronary calcium scores are more motivated to listen to their doctors' advice after they've surveyed the damage themselves, results of two studies show.
Here at the American College of Cardiology (ACC) 2012 Scientific Sessions, Dr Nove Kalia (University of Saskatchewan, Saskatoon) today presented results of two studies of patients who were shown the computed-tomography (CT) calcium scans of their coronary arteries. After seeing these images, patients with the most disease showed the greatest willingness to stick to their statin therapy and lose weight.
As reported by heartwire , Kalia's group previously demonstrated that visualizing coronary calcium improves patient use and adherence to lipid-lowering therapy, but the studies presented at ACC are the first large studies to corroborate those results with statistically significant findings across all coronary artery calcium (CAC) scores. "In this era of economic austerity, focusing on compliance and adherence is probably a very important way for us to achieve the results that we want to in patient care," he said.
In a study of 2100 patients taking statins, follow-up questionnaires showed that only 36% of patients with a CAC score of zero were compliant with their prescribed statin regimen. However, just over half patients with CAC scores of 1 to 400 and almost 60% of patients with a CAC score over 400 (severe) were compliant with their prescribed statin regimen (p<0.001 for trend). Adjusted for age, gender, and race, patients with any coronary calcium were at least twice as likely to stick to their statin regimen and patients with severe coronary calcification were 2.6 times as likely to be compliant compared with patients with a CAC score of zero.
Although a CAC score below 600 is not necessarily predictive of future adverse events, all patients were indicated for statins, as determined by their physician, Kalia explained. "The extra motivation from visualizing these images is helpful and probably translates into reduced long-term coronary artery disease."
A second study by Kalia et al of 518 patients who saw their CAC CT scan found that patients with a CAC score of zero were much less likely to lose weight than those with severe CAC. Only 20% of patients with no CAC evident on their CT scan lost weight compared with 40% of patients with CAC scores over 400. As in the statin study, after adjustment for age, race, and gender, statistical analysis showed that patients with any CAC were at least twice as likely to lose weight as those with a CAC score of zero. Patients with CAC scores of 100 to 400 were 3.6 times as likely as those with a CAC score of zero to lose weight, and patients with a CAC score of over 400 were 3.3 times as likely as those with no CAC to lose weight (p<0.001).
Kalia said that at Harbor-UCLA Medical Center, where the study was performed, all patients see select images of their coronary CT scan and are given a formal score report. CT is not used as frequently at the University of Saskatchewan, where Kalia currently practices, but patients see images of their diagnostic angiograms, and "seeing the picture really changes the way they adhere to medicines or lifestyle modification."
Kalia reported no conflicts of interest.
Heartwire from Medscape © 2012 Medscape, LLC
Cite this: Patients With High Calcium Score More Likely to Lose Weight, Take Statins - Medscape - Mar 24, 2012.