ArticlePloS one2015
Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA).
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 98 citations in OpenAlex.
- The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis.JACC. Cardiovascular imaging · 2017Pooled it
- Cardiovascular imaging for the detection of asymptomatic coronary artery disease: an updated systematic review of clinical practice guidelines.European heart journal. Imaging methods and practice · 2026Article
- Impact of coronary artery calcium scores on cardiovascular risk and preventive therapies: A systematic review and meta-analysis.Global cardiology science & practice · 2025Review
- Cost-Effectiveness of Coronary Artery Calcium Scoring for Cardiovascular Disease Prevention in Diabetes: An Analysis From MESA.Journal of the American Heart Association · 2025Article
- Beyond Traditional Risk Calculators: The Expanding Role of Coronary Artery Calcium Scoring in Preventive Cardiology.Cureus · 2025Review
- Impact of Zero Coronary Artery Calcium Scoring on Downstream Cardiac Testing and Cardiac Outcomes Compared With No Testing.CJC open · 2025Article
- Fully automated coronary artery calcium score and risk categorization from chest CT using deep learning and multiorgan segmentation: A validation study from National Lung Screening Trial (NLST).International journal of cardiology. Heart & vasculature · 2025Article
- Cost-utility analysis of Coronary Artery Calcium screening to guide statin prescription among intermediate-risk patients in Thailand.PloS one · 2025Article
- Computed Tomography Evaluation of Coronary Atherosclerosis: The Road Travelled, and What Lies Ahead.Diagnostics (Basel, Switzerland) · 2024Review
- Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries.European radiology · 2024Article
- Canadian Cost-Effectiveness of Coronary Artery Calcium Screening Based on the Multi-Ethnic Study of Atherosclerosis.JACC. Advances · 2024Article
- Article
- Comparison of Coronary Artery Calcium and Quantitative Coronary Plaque in Predicting Obstructive Coronary Artery Disease: Subgroup Analysis of the CLARIFY Study.Heart international · 2024Article
- Article
- Coronary calcium scoring for guiding lipid-lowering therapy is cost-effective: time to remove barriers to its use.The Medical journal of Australia · 2023Article
- 2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome.Acta Cardiologica Sinica · 2023Article
- Subclinical cardiovascular disease and utility of coronary artery calcium score.International journal of cardiology. Heart & vasculature · 2021Review
- Atherosclerotic cardiovascular disease events among statin eligible individuals with and without long-term healthy arterial aging.Atherosclerosis · 2021Article
- Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.Hypertension (Dallas, Tex. : 1979) · 2021Article
- An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT.Radiology. Cardiothoracic imaging · 2021Review
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundThe Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels <160 mg/dL. However, the cost-effectiveness of incorporating CAC into treatment decision rules has yet to be clearly delineated.
objectiveTo model the cost-effectiveness of CAC for cardiovascular risk stratification in asymptomatic, intermediate risk patients not taking a statin. Treatment based on CAC was compared to (1) treatment of all intermediate-risk patients, and (2) treatment on the basis of United States guidelines.
methodsWe developed a Markov model of first coronary heart disease (CHD) and cardiovascular disease (CVD) events. We modeled statin treatment in intermediate risk patients with CAC≥1 and CAC≥100, with different intensities of statins based on the CAC score. We compared these CAC-based treatment strategies to a "treat all" strategy and to treatment according to the Adult Treatment Panel III (ATP III) guidelines. Clinical and economic outcomes were modeled over both five- and ten-year time horizons. Outcomes consisted of CHD and CVD events and Quality-Adjusted Life Years (QALYs). Sensitivity analyses considered the effect of higher event rates, different CAC and statin costs, indirect costs, and re-scanning patients with incidentalomas.
resultsWe project that it is both cost-saving and more effective to scan intermediate-risk patients for CAC and to treat those with CAC≥1, compared to treatment based on established risk-assessment guidelines. Treating patients with CAC≥100 is also preferred to existing guidelines when we account for statin side effects and the disutility of statin use.
conclusionCompared to the alternatives we assessed, CAC testing is both effective and cost saving as a risk-stratification tool, particularly if there are adverse effects of long-term statin use. CAC may enable providers to better tailor preventive therapy to patients' risks of CVD.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.