Leslee Shaw explains coronary artery calcium scoring

On Thursday, cardiology researcher Leslee Shaw, PhD joined an exclusive club at Emory with her 2015 Dean’s Distinguished Faculty Lecture and Award.* Shaw is the co-director of Emory’s Clinical Cardiovascular Research Institute and research director of Emory Women’s Heart Center. Her lecture focused on the utility of coronary artery calcium (CAC) scoring in predicting cardiovascular disease.

Much cardiovascular risk research has focused on finding imaging or biomarker tests that can provide doctors with cost-effective decision-making power. One prominent question: should the patient take cholesterol-reducing statins? These tests should provide information above and beyond the Framingham Risk Score or its ACC/AHA update, which incorporates information about a patient’s age, sex, cholesterol/HDL, blood pressure and diabetes status.

CAC scoring is a good place to start, Shaw said, since it is a standardized, relatively inexpensive test that measures the buildup of calcium in atherosclerotic plaque, and the radiation dose is low compared with other cardiac imaging techniques.

Shaw’s research on how CAC scoring can predict the risk of death over the next 15 years, both in patients with a family history of heart disease and those without, was presented last year at the American College of Cardiology meeting in Washington DC.

“This suggests there may be a benefit to expanding CAC testing to all low-risk patients, regardless of their family history, allowing patients to learn about their risks sooner and take actions to decrease them,” Emory’s news release says.

In her talk Thursday, Shaw touched on results from the EISNER study (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research, co-incidentally supported by the Eisner Foundation) as well as the MESA study.

Shaw mentioned that a couple years ago, she had pushed officials at the NHLBI to support an even larger randomized study that would look at cardiovascular disease risk with and without CAC scoring.

The impact might have been comparable to the 2011 study that looked at CT screening for lung cancer, she said. However, the proposed heart study would have needed a similarly large number of participants (40,000?) and officials balked at the $200+ million cost.

Even so, Shaw is part of another large study that may have considerable impact as well: the NHLBI’s 8000-patient ISCHEMIA trial, which is designed to compare strategies for treatment of stable coronary artery disease.

Shaw has a recent editorial in JACC commenting on the confounding results from a study seeming to show that statin treatment leads to denser coronary artery calcium. An excerpt:

“This remains a never-ending story that is incompletely defined but vital to addressing the detection gap for atherosclerotic disease. Identification of the vulnerable patient remains elusive and without established treatment targeted to known atherosclerotic disease pathways that would lead to effective risk reduction.”

*Past awardees include Stephen Warren, Don Stein, Rafi Ahmed, Kerry Ressler and Kathy Griendling.

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Quinn Eastman

Science Writer, Research Communications qeastma@emory.edu 404-727-7829 Office

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