Annual progression of coronary calcification in trials of preventive therapies: a systematic review - PubMed (original) (raw)
Annual progression of coronary calcification in trials of preventive therapies: a systematic review
Peter A McCullough et al. Arch Intern Med. 2009.
Abstract
Background: Coronary artery calcification (CAC) measured by computed tomography is radiographic confirmation of atherosclerosis, predicts cardiovascular events, and has been evaluated as a surrogate measure in randomized trials.
Methods: We performed a literature search for prospective randomized trials in which CAC was measured at baseline and at 1 year or more of follow-up. We computed the weighted mean annualized rate of CAC progression for a variety of therapies tested in these trials.
Results: Ten trials (n = 2612) met our criteria and were included. Electron-beam, double-helix, and multislice computed tomography were used in 6, 2, and 2 trials, respectively. Agatston (8 trials) and volumetric (2 trials) methods were used for CAC evaluation. In 5 trials in subjects with cardiovascular disease (CVD) (n = 2135; age, ~64 years; ~39% women; follow-up, ~26 months), therapies included statins (n = 1370), placebo (n = 564), and antihypertensives (n = 201). In 5 trials in subjects with chronic kidney disease (n = 477; age, ~55 years; ~34% women; follow-up, ~14 months), interventions included low-phosphorus diet (n = 29), sevelamer hydrochloride (n = 229), and calcium-based phosphate binders (n = 219). The mean (SD) weighted annualized CAC increase overall and in patients with CVD and chronic kidney disease was 17.2% (6.7%), 16.9% (5.2%), and 18.4 (11.1%), respectively (P < .001). The rate among those assigned blinded placebo was 14.6% (1.0%) (2 trials). There was no consistent or reproducible treatment effect of any therapy on this outcome measured at 1 year.
Conclusion: The 1-year change in CAC does not appear to be a suitable surrogate end point for treatment trials in patients with CVD or chronic kidney disease.
Comment in
- A double take on serial measurement of coronary artery calcification.
O'Malley PG. O'Malley PG. Arch Intern Med. 2009 Dec 14;169(22):2051-2. doi: 10.1001/archinternmed.2009.418. Arch Intern Med. 2009. PMID: 20008686 No abstract available. - Progression of coronary artery calcification: not down-and-out.
McEvoy JW, Blaha MJ. McEvoy JW, et al. Arch Intern Med. 2010 Apr 26;170(8):735-6; author reply 736. doi: 10.1001/archinternmed.2010.60. Arch Intern Med. 2010. PMID: 20421563 No abstract available.
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