"The rate of progression of calcium scores was less," says Victor K. Goh, M.D., consultant cardiologist at the Electron Beam Center, Matilda International Hospital in Hong Kong. "Statin therapy, in addition to lifestyle modification, induced a 32 percent rate of reduction in the coronary calcium scores in asymptomatic patients."
This study shows that that early detection and treatment can prevent coronary artery disease from progressing – and in some cases, allows the disease to regress.
The EBT scan detects levels of calcium deposited on cholesterol plaques in the arteries, which can deteriorate and thus lead to blockages requiring revascularization procedures such as angioplasty, stenting or bypass surgery. A calcium score is then ascertained by the amount of calcium discovered in the arteries.
"If the patients have risk factors for coronary artery disease and by electron beam tomography are found to have coronary disease, then adopting a healthy lifestyle (a diet and exercise program) and being placed on statins can do a lot to alleviate the problem," Goh says. The study involved 102 patients who underwent EBT in 1990-1992 then again 12 years later. These people, all at high risk for coronary artery disease, were given physical examinations and calcium scores, then placed on statins and lifestyle modification including diet, exercise and weight control.
Although most patients stayed on statins, many that initially adopted a healthy lifestyle became slack in their diet and exercise programs. Only 27 patients adhered to the aggressive lifestyle changes all the way, Goh says.
The average calcium scores for the entire group was 125. The average increase in calcium scores each year was 24 percent. But annual calcium scores of patients on both statin therapy and aggressive lifestyle changes had an increase of only 16.4 percent. Those who were untreated had an increase of 38.2 percent per year.
Almost one-third of the enrolled patients taking statins and adopting lifestyle changes had reduced calcification scores, Goh says. "These patients did not want stenting or surgical intervention, even if they were found to have significant blockages," he says. "But treatment with statins and aggressive life-style changes helped them avoid revascularization procedures."
In the whole group, only one patient suffered a non-fatal myocardial infarction and two suffered strokes. There were no deaths, nor revascularization procedures. Among high-risk patients taking statins and adhering to lifestyle modifications, the event rate was below one percent.
Goh advised that patients appear at high risk for coronary artery disease, physicians should prove it with an EBT scan. "Once disease is proven, then statins and aggressive lifestyle changes are very effective treatments," he says. "This approach has a lot of potential." The American Health Association does not recommend EBCT for routine screening of the population. It can be helpful to assess individuals at intermediate risk for coronary heart disease.
Co-author is Matthew Budoff.
NR03-1085 (AP/Goh)
Abstract P21