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Researchers at Wake Forest Baptist Medical Center have claimed that heart calcium scans are far superior to other assessment tools in predicting the development of cardiovascular disease in individuals currently classified at intermediate risk by their doctors. The test, coronary artery calcium (CAC), uses a CT scan to detect calcium build-up in the arteries around the heart. 

The findings are published in the Journal of the American Medical Association.

Currently, doctors classify patients as high, intermediate or low risk using the Framingham Risk Score (FRS). Now, doctors are second-guessing the FRS model, claiming that the intermediate group actually includes some individuals who could benefit from more aggressive drug therapy, as well as individuals who could be managed solely with lifestyle measures.

"We know how to treat patients at low and high risk for heart disease, but for the estimated 23 million Americans who are at intermediate risk, we still are not certain about the best way to proceed," Joseph Yeboah, lead author of the study, said. 

Researchers observed 1,330 patients who were considered at intermediate risk. The researchers determined that the CAC score proved the best in predicting which among the intermediate-risk people would go on to have heart disease in the ensuing 7.5 years (average) of follow-up observation.

Researchers evaluated which of the top-tier assessment tools best identified people within the intermediate group who were actually at higher or lower risk. 

Determining the relative improvements in prediction afforded by various tests, especially when used in conjunction with the FRS, could help identify intermediate-risk people who may benefit from more aggressive primary prevention interventions, including the use of aspirin and the setting of lower targets for drug treatment of LDL cholesterol and blood pressure. 

"If we want to concentrate our attention on the subset of intermediate-risk patients who are at the highest risk for cardiovascular disease, CAC is clearly the best tool we have in our arsenal to identify them," Yeboah said. "However, we have to look at other factors such as costs and risks associated with radiation exposure from a CT scan before deciding if everyone in the intermediate group should be screened."

Yeboah said more research is needed to explore the costs, benefits and risks of widespread use of CAC screening in people at risk of heart disease.