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Showing EBT Results to Patients Doesn't Help

Primary prevention of coronary disease should focus instead on detecting and modifying known risk factors.

Whether electron beam tomography (EBT) is useful in screening asymptomatic patients for coronary artery disease is controversial. Some have touted using EBT results to motivate patients to modify CAD risk factors, regardless of the value for screening. Does this motivational technique actually work? To find out, researchers randomized 450 asymptomatic U.S. Army personnel (age range, 39 to 45) to 1 of 4 strategies: EBT results plus usual care, intensive case management (ICM) focused on lifestyle modification of CAD risk factors, EBT plus ICM, or usual care alone. ICM involved 6 contacts with nurses and dietitians.

At 1 year, the mean change in projected 10-year Framingham risk score (FRS) did not differ significantly between participants who received EBT results and those who did not. Compared with usual-care recipients, ICM recipients had a significant reduction in projected FRS, regardless of whether they had received EBT results. Findings were not affected significantly by whether EBT results showed evidence of calcification (15% of patients) or not. In multivariate analysis, the only 2 variables associated with improved projected FRS were higher number of modifiable baseline CAD risk factors and receipt of ICM.

Comment: In one of the first randomized trials to assess EBT's motivational value, an unselected cohort of young, asymptomatic adults derived no additional improvement in modifiable risk from EBT beyond that provided by intensive case management. As an editorialist notes, until data from a randomized, controlled trial show a positive effect of EBT on risk-factor modification and on outcomes, primary prevention should focus on detecting and modifying known risk factors.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology July 4, 2003

Citation(s):

O'Malley PG et al. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: A randomized controlled trial. JAMA 2003 May 7; 289:2215-23.

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Greenland P. Improving risk of coronary heart disease: Can a picture make the difference? JAMA 2003 May 7; 289:2270-2.

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• Medline abstract (Free)