Fasting Reduces Your Cardiovascular Risk

Intermittent energy restriction diets such as the 5:2 diet clears fat from the blood quicker after eating meals compared with daily calorie restriction diets, reducing an important risk factor for cardiovascular disease, a new study in the British Journal of Nutrition reports.

Intermittent fasting allows the body to use fat as it’s primary source of energy instead of sugar and there are five huge benefits.

In the first study of its kind, researchers from the University of Surrey examined the impact of the 5:2 diet on the body’s ability to metabolise and clear fat and glucose after a meal and compared it to the effects of weight-loss achieved via a more conventional daily calorie restriction diet. Previous studies in this field have predominantly focused on blood risk markers taken in the fasted state, which only tend to be, in for the minority of the time, overnight.

The simplicity of the diet and the fact you can eat pretty much what you like five days a week, are key to its popularity. Dieters are recommended to consume a ‘normal’ number of calories five days a week and then, for two, non-consecutive days, eat just 25% of their usual calorie total – 500 calories for women and 600 for men.

There are no restrictions on the types of food you can eat and it is suggested that women can expect to lose about a 1lb a week on the diet with men losing about the same if not a little more.

During the study, overweight participants were assigned to either the 5:2 diet or a daily calorie restriction diet and were required to lose five per cent of their weight. Those on the 5:2 diet ate normally for five days and for their two fasting days consumed 600 calories, using LighterLife Fast Foodpacks, whilst those on the daily diet were advised to eat 600 calories less per day than their estimated requirements for weight maintenance (in the study women ate approx. 1400 calories, men ate approx. 1900 calories/day).

Under the expert guidance of the team, those on the 5:2 diet achieved 5 per cent weight-loss in 59 days compared to those on the daily calorie restriction diet who took in 73 days. 27 participants completed the study, with approximately 20 per cent of participants in both groups dropped out because they either could not tolerate the diet or were unable to attain their 5 per cent weight-loss target.

Researchers found that following weight-loss, participants who followed the 5:2 diet cleared the fat (triglyceride) from a meal given to them more efficiently than the participants undertaking the daily diet. Although there were no differences in post meal glucose handling, researchers were surprised to find differences between the diets in c-peptide (a marker of insulin secretion from the pancreas) following the meal, the significance of which will need further investigation.

The study also found a greater reduction in systolic blood pressure (the pressure in your blood vessels when your heart beats) in participants on the 5:2 diet. Systolic blood pressure was reduced by 9% of following the 5:2, compared to a small 2% increase among those on the daily diet. A reduction in systolic blood pressure reduces pressure on arteries, potentially lessening incidences of heart attacks and strokes.

Dr Rona Antoni, Research Fellow in Nutritional Metabolism at the University of Surrey, said:

“As seen in this study, some of our participants struggled to tolerate the 5:2 diet, which suggests that this approach is not suited to everybody; ultimately the key to dieting success is finding an approach you can sustain long term.

“But for those who do well and are able stick to the 5:2 diet, it could potentially have a beneficial impact on some important risk markers for cardiovascular disease, in some cases more so than daily dieting. However, we need further studies to confirm our findings, to understand the underlying mechanisms and to improve the tolerability of the 5:2 diet.”

Lyxumia trial shows neutral CV risk in adults with type 2 diabetes, high risk for CVD

The GLP-1 receptor agonist Lyxumia lowers HbA1c without any cardiovascular risk or benefit in adults with type 2 diabetes at high risk for acute cardiovascular events, according to study findings presented here.

In announcing results from the ELIXA cardiovascular outcomes study, a worldwide randomized, double blind, placebo-controlled trial, researchers also found no increased risk for hypoglycemia or pancreatic injury among participants assigned Lyxumia (lixisenatide, Sanofi), as well as a modest benefit on weight after 3 years of treatment.

“In these high risk patients, we’re safe from a cardiovascular point of view, favorable on some metabolic points of view,” Marc Pfeffer, MD, PhD, of Harvard Medical School and Brigham and Women’s Hospital, said in a press conference announcing the results of the study. “This should provide physicians and patients reassurance for this adjunctive therapy to better control their glucose status.”

Pfeffer, one of the investigators for the ELIXA trial, Rhonda M. Bentley-Lewis, MD, MBA, of Massachusetts General Hospital, and colleagues at other institutions analyzed data from 6,068 adults from 49 countries with type 2 diabetes, an HbA1c of 7.5% and acute post-coronary syndrome within 180 days of randomization (mean age, 60 years; 30% female, 76% white; mean BMI 30). Within the cohort, 3,034 participants were assigned an initial dose of 10 mcg once daily of lixisenatide; the dosage was then increased to 20 mcg once per day. Site investigators were permitted to adjust the dose as needed up to the maximum of 20 mcg per day during the study period. The remaining participants (n = 3,034) were assigned a matching placebo.

Participants in both arms had a mean diabetes duration of 9 years, a mean fasting glucose of 149 and an mean HbA1c of 7.7%.

Matthew Riddle

Matthew Riddle

Prior to their index acute coronary event, 22% of participants in both groups experienced myocardial infarction. Prior to randomization, 22% of participants in both groups experienced heart failure. The mean time period between acute coronary syndrome and randomization was 72 days.

Following a 3-year study period, cardiovascular outcomes were similar in the two treatment arms, with a hazard ratio of 1.02 for CV death, MI, stroke or angina; a hazard ratio of 0.96 for hospitalization due to heart failure and a hazard ratio of 0.94 for all-cause death.

Participants assigned lixisenatide saw a modest reduction in HbA1c over 3 years vs. participants assigned placebo (mean post-baseline difference, -0.27%), a mean weight decrease of .7 kg and an .8 mm Hg decrease in blood pressure.

The weight loss and blood pressure numbers “are small, but with big numbers [of participants] in the study, statistically significant and perhaps clinically significant,” Matthew Riddle, MD, of Oregon Health & Science University, said during the press conference.

Heart rate was not affected, according to researchers.

Adverse effects seen in similar studies, including nausea and vomiting, were increased in the lixisenatide group, leading to discontinuation of the drug in just under 5% of participating patients, Pfeffer said.

Researchers found no increase in pancreatitis or pancreatic cancer among participants, as well as no increase in incidents of severe hypoglycemia. – by Regina Schaffer


Bentley-Lewis R, et al. Rationale, design and baseline characteristics in evaluation of lixisenatide in acute coronary syndrome, a long-term cardiovascular endpoint trial of lixisenatide vs. placebo. Presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston.

Statins for Young T1D Patients, Too?

Type 1 diabetes patients younger than 40 may be candidates for statin use, as guidelines recommend after age 40, researchers suggested.

Under the American Heart Association/American College of Cardiology definition, the 10-year cardiovascular risk was about 5% for type 1 diabetes patients ages 30 to 39 and about 13% in those ages 40 to 44, Rachel G. Miller, MD, of the University of Pittsburgh, and colleagues found.

Adding coronary revascularization to that definition — which also included cardiovascular death or nonfatal stroke or myocardial infarction — brought the 10-year risk to nearly 7% for type 1 diabetes patients in their 30s, the group reported here at the American Diabetes Association meeting.

Although still a little shy of the 7.5% 10-year risk threshold recommended for statin treatment in the guidelines, the 20% of the cohort already on a statin before age 40 was excluded along with a number of events that happened before the start of follow-up.

“We conclude that young adults aged 30 to 39 years with 20 or less years’ type 1 diabetes duration are at sufficiently high atherosclerotic cardiovascular disease risk to merit statin therapy,” the group concluded in their poster presentation.

Both the AHA/ACC and the American Diabetes Association guidelinesrecommend statins after 40 for essentially all diabetes patients and support possible use for younger people with cardiovascular disease risk factors.

“We’ve been comfortable with the concept that anybody over the age of 40 with type 2 should be on a statin and by extrapolation anybody who has type 1 over the age of 40 should be recommended for statins,” commentedNaveed Sattar, MD, a metabolic medicine specialist at the University of Glasgow, Scotland.

“What we now need is good guidance: Who are these people under 40 with type 1 who should get a statin, and how do we recognize them?” he toldMedPage Today.

There isn’t enough data to develop a risk score for type 1 diabetes yet, he noted. Lifetime risk might be a better criterion in that population than the 10-year risks, which are heavily predicated upon age and which underpin current guidelines, Sattar noted.

“I think in the next 2 or 3 years either from national databases within Scandinavia or Scotland we’re going to have a type 1 diabetes risk score that might allow us to look at this question,” he suggested.

Comparisons with the general population in the surrounding county showed huge elevations in risk with type 1 diabetes even at these early ages, but absolute event numbers were small in Miller’s study.

Among the 517 people under age 45 without pre-existing atherosclerotic cardiovascular disease followed from 1996 to 2011 in the Pittsburgh Epidemiology of Diabetes Complications study (a prospective group of childhood-onset cases seen at a single center soon after diagnosis):

  • One event occurred in 20- to 29-year-olds
  • 18 accrued in those in their 30s
  • 22 occurred in participants in their early 40s

The fatal coronary artery event and nonfatal stroke or MI rates were 134 per 100,000 in the cohort ages 20 to 29, 502 per 100,000 people in their 30s, and 1,336 per 100,000 in the 40 to 44 age range.

Sattar cautioned against overinterpreting the “very crude analysis.”

EMA Committee Warns of Small Cardiovascular Risk With High-Dose Ibuprofen

The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) is warning of an increased risk of cardiovascular events in patients who take high doses of the anti-inflammatory ibuprofen[1].

The committee, which began its review in 2014, states there is a small increase in the risk of MI and stroke with ibuprofen when taken at doses of 2400 mg/day or higher. The risk, according to the committee, is similar to the risk observed with other nonsteroidal anti-inflammatory drugs (NSAIDs), such as COX-2 inhibitors and diclofenac.
In 2013, as reported by heartwire , researchers published data showing diclofenac, a drug used for pain and inflammation, increased the risk of cardiovascular events between 38% and 63% in different studies. The EMA reached similar conclusions in 2012, concluding there was a consistent but small increase in the risk of cardiovascular side effects with diclofenac compared with other NSAIDs.

The committee is recommending physicians assess patients’ risk factors for cardiovascular conditions before starting them on long-term high-dose ibuprofen. Overall, PRAC says the benefits of high-dose ibuprofen outweigh the small increased risk of cardiovascular events, but physicians should use caution when prescribing and avoid high-dose ibuprofen in select patients.

“High doses of ibuprofen (2400 mg per day or higher) should be avoided in patients with serious underlying heart or circulatory conditions, such as heart failure, heart disease, and circulatory problems or in those who have previously had a heart attack or stroke,” according to PRAC.

With 1200 mg of ibuprofen, the most commonly used over-the-counter dose of ibuprofen in the European Union, there is no signal of harm, according to PRAC. The recommendations of the committee also extend to dexibuprofen, which is similar to ibuprofen. A high-dose of dexibuprofen is 1200 mg/day or more.

The recommendations of PRAC will now be sent to the Coordination Group for Mutual Recognition for Decentralized Procedures—Human (CMDh). The CMDh reviews the recommendations of PRAC and will adopt a final position.



Nanoparticles, extremely tiny particles measured in billionths of a meter, are increasingly everywhere, and especially in biomedical products. Their toxicity has been researched in general terms, but now a team of Israeli scientists has for the first time found that exposure nanoparticles (NPs) of silicon dioxide (SiO2) can play a major role in the development of cardiovascular diseases when the NP cross tissue and cellular barriers and also find their way into the circulatory system. Their study is published in the December 2014 issue of Environmental Toxicology.

The research team was comprised of scientists from the Technion Rappaport Faculty of Medicine, Rambam Medical Center, and the Center of Excellence in Exposure Science and Environmental Health (TCEEH).

“Environmental exposure to nanoparticles is becoming unavoidable due to the rapid expansion of nanotechnology,” says the study’s lead author, Prof. Michael Aviram, of the Technion Faculty of Medicine, “This exposure may be especially chronic for those employed in research laboratories and in high tech industry where workers handle, manufacture, use and dispose of nanoparticles. Products that use silica-based nanoparticles for biomedical uses, such as various chips, drug or gene delivery and tracking, imaging, ultrasound therapy, and diagnostics, may also pose an increased cardiovascular risk for consumers as well.”

In this study, researchers exposed cultured laboratory mouse cells resembling the arterial wall cells to NPs of silicon dioxide and investigated the effects. SiO2 NPs are toxic to and have significant adverse effects on macrophages. a type of white blood cell that take up lipids, leading to atherosclerotic lesion development and its consequent cardiovascular events, such as heart attack or stroke. Macrophages accumulation in the arterial wall under atherogenic conditions such as high cholesterol, triglycerides, oxidative stress – are converted into lipids, or laden “foam cells” which, in turn, accelerate atherosclerosis development.

“Macrophage foam cells accumulation in the arterial wall are a key cell type in the development of atherosclerosis, which is an inflammatory disease” says co-author Dr. Lauren Petrick. “The aims of our study were to gain additional insight into the cardiovascular risk associated with silicon dioxide nanoparticle exposure and discover the mechanisms behind Si02’s induced atherogenic effects on macrophages. We also wanted to use nanoparticles as a model for ultrafine particle (UFP) exposure as cardiovascular disease risk factors.”

Both NPs and UFPs can be inhaled and induce negative biological effects. However, until this study, their effect on the development of atherosclerosis has been largely unknown. Here, researchers have discovered for the first time that the toxicity of silicon dioxide nanoparticles has a “significant and substantial effect on the accumulation of triglycerides in the macrophages,” at all exposure concentrations analyzed, and that they also “increase oxidative stress and toxicity.”

A recent update from the American Heart Association also suggested that “fine particles” in air pollution leads to elevated risk for cardiovascular diseases. However, more research was needed to examine the role of “ultrafine particles” (which are much smaller than “fine particles”) on atherosclerosis development and cardiovascular risk.

“The number of nano-based consumer products has risen a thousand fold in recent years, with an estimated world market of $3 trillion by the year 2020,” conclude the researchers. “This reality leads to increased human exposure and interaction of silica-based nanoparticles with biological systems. Because our research demonstrates a clear cardiovascular health risk associated with this trend, steps need to be taken to help ensure that potential health and environmental hazards are being addressed at the same time as the nanotechnology is being developed.

The Technion-Israel Institute of Technology is a major source of the innovation and brainpower that drives the Israeli economy, and a key to Israel’s renown as the world’s “Start-Up Nation.” Its three Nobel Prize winners exemplify academic excellence. Technion people, ideas and inventions make immeasurable contributions to the world including life-saving medicine, sustainable energy, computer science, water conservation and nanotechnology. The Joan and Irwin Jacobs Technion-Cornell Innovation Institute is a vital component of Cornell NYC Tech, and a model for graduate applied science education that is expected to transform New York City’s economy.

Ghrelin paralleled adiposity increase after acromegaly surgery

The rise in total ghrelin found to accompany some remaining cardiovascular risk markers and adiposity increase in patients with acromegaly remission after surgery could be interrelated, according to research published in The Journal of Clinical Endocrinology & Metabolism.

“Our prospective study found increases in weight and central adiposity after surgery for acromegaly along with reductions in many, but not all, markers of cardiovascular risk,” the researchers wrote. “Ghrelin levels rose in parallel with the less favorable anthropometric profile, novel evidence of a possible relationship of ghrelin to the increase in adiposity that follows surgical treatment of acromegaly mechanisms and long-term implications of changes with acromegaly treatment.”

At tertiary referral centers for pituitary tumors, Carlos Reyes-Vidal, MD, of the Columbia University College of Physicians and Surgeons, New York, and colleagues looked at 42 adults who had untreated active acromegaly before surgery.

The researchers evaluated changes in outcome measures from before to after surgery in 26 patients who achieved remission, or normal insulin-like growth factor I and 16 patients whose active acromegaly, or elevated IGF-I, persisted.

By 6 months, patients with remission had increases in total ghrelin, body weight, waist circumference, C-reactive protein, homocysteine, HDL and leptin, and decreases in systolic blood pressure, homeostasis model assessment, triglycerides and lipoprotein(a); the changes remained for 32 ± 4 months after surgery. Higher ghrelin correlated with the reduced levels of growth hormone, IGF-I and insulin and insulin resistance.

Patients with persistent active acromegaly did not demonstrate significant increases in weight, waist circumference and ghrelin. In 15 patients with remission, total body fat, trunk fat and percentage total body fat increased by 1 year after surgery: Increase in body fat correlated with increase in total ghrelin.
“It is unknown whether the changes represent a readjustment to the anthropometric and cardiovascular risk profile they would have were they not to have acromegaly,” the researchers wrote. “Further investigation into the mechanisms of these changes and their long-term implications is warranted.”

Questions Remain in Cholesterol Research.

It’s well established that lowering LDL cholesterol reduces cardiovascular risk, but the story of HDL is much less certain, according to a review series on lipidology published in The Lancet ahead of the European Society of Cardiology meeting.

Still, several questions about LDL remain, according to Paul Ridker, MD, of Brigham and Women’s Hospital in Boston: Can other LDL-lowering drugs besides statins reduce cardiovascular risk? Are treatment targets needed? Is aggressive lowering safe?

The three papers and an editorial delve into the knowns and unknowns of LDL, HDL, and triglycerides.

Action Points

  • Note that the latest issue of the Lancet contains several perspectives on the state of research regarding the relationship between lipid fractions and cardiovascular disease.
  • While it seems clear that LDL is causally linked to cardiovascular disease, the data is not as strong for HDL and triglycerides.

Latest on LDL

There’s “extensive evidence” that LDL predicts vascular risk and is a causal factor in atherosclerosis, but there’s still plenty of controversy with regard to specific issues within cholesterol management, Ridker wrote — particularly in light of recent U.S. guidelines that remove treatment targets for LDL levels.

Treating to target is a mainstay of therapy for most other nations, Ridker wrote, but the U.S. guidelines instead advocate for the use of higher-intensity statins in patients with higher absolute risk of cardiovascular events.

Other questions include how and when lipid fractions should be measured, whether population-based screening is useful, why certain drugs that lower LDL have not shown the same benefits as statins, and whether aggressive LDL lowering is safe.

Ridker also characterizes the landscape of new pharmacological strategies for LDL lowering, noting the recent lack of success with CETP inhibitors torcetrapib and dalcetrapib, which reduced LDL cholesterol but didn’t diminish vascular event rates in trials.

Other approaches are under investigation, including two drugs which were approved for homozygous familial hypercholesterolemia in 2013: mipomersen and lomitapide. Mipomersen is an antisense oligonucleotide that interferes with apolipoprotein transcription; lomitapide inhibits microsomal triglyceride transport protein (MTP).

But the “most promising” new drugs for additional LDL lowering are the PCSK9 inhibitors, which block a protein secreted by hepatocytes that impairs the action of the LDL receptor, Ridker said.

“Efficacy and safety data from hard-endpoint trials will be available soon for several novel therapeutic approaches that reduce LDL cholesterol well below the concentrations that are currently achievable with statins alone,” he wrote.

What Happened to HDL?

Although there’s solid evidence that HDL is a key component of predicting cardiovascular risk, there’s no clear causal relationship between HDL and atherosclerosis, according toDaniel Rader, MD, of the University of Pennsylvania, and Kees Hovingh, MD, of the University of Amsterdam.

Now, the “HDL hypothesis” has been recast as a “more subtle concept” — the HDL function hypothesis, which posits that it may not be HDL cholesterol itself that has a causal relationship to atheroprotection, but instead HDL’s function that is protective.

“The classic HDL hypothesis — defined as the concept that intervention to raise HDL cholesterol concentrations will reduce cardiovascular risk — is questionable and is increasingly difficult to defend in its simplest form,” they wrote, noting, however, that it is “important to emphasize that its value as a predictor of cardiovascular risk remains largely unchallenged.”

The methods for measuring HDL function are in the early stages and are vastly more complex than the current standard of measuring HDL mass, and new tests should be “reproducible, straightforward to measure, and show an association with coronary heart disease outcome measures,” they wrote.

Attention Back on Triglycerides

Before statins stole the spotlight with their focus on LDL lowering, high triglycerides were once treated with the aim of preventing cardiovascular disease.

“As time went by, the randomized evidence for treating raised triglycerides to prevent cardiovascular disease seemed weaker and weaker,” wrote Borge Nordestgaard, MD, DMSc, and Anette Varbo, MD, PhD, of the University of Copenhagen.

But now that HDL research has painted an uncertain picture, there’s a renewed interest in triglycerides — which are strongly inversely linked with HDL levels, the researchers said.

Randomized trials showing the cardiovascular benefits of triglyceride reduction are scarce, they wrote, but that may be remedied by upcoming studies of new triglyceride-lowering drugs, which will “hopefully provide conclusive evidence as to whether lowering triglycerides reduces the risk of cardiovascular disease.”

In an accompanying editorial, John Kastelein, MD, PhD, of the University of Amsterdam, echoed the researchers’ sentiments that “few clinicians have any doubt about [LDL’s] causal role in heart disease,” while answers about HDL are still “very far away.”

“Fortunately, all three lipoproteins (LDL, HDL, and triglycerides) share the fact that new therapies to address them are under investigation in outcome trials,” he wrote, hoping that these trials will answer some of the most important questions in the specialty over the next 5 years:

  • Will LDL cholesterol reduction by modalities other than statins yield similar outcome benefits?
  • Will lowering of triglyceride-rich lipoproteins and remnant cholesterol result in a reduction of major adverse cardiovascular events?
  • Will infusion of pre-beta-like HDL particles to promote reverse cholesterol transport from macrophage to circulation lead to an improvement in coronary artery disease risk?

“After a wait of 20 years,” he wrote, “we will have to hold our breath a little longer.”

Coronary Artery Calcium Scores Vary Widely Among Scanners.

Up to 6.5% of people classified as being at intermediate cardiovascular risk could be misclassified, depending on which brand of CT scanner was used to calculate their coronary artery calcium score, a new study suggests.

“We found that calcium scores differed substantially among state-of-the-art CT systems from 4 major vendors. Subsequently, simulation showed that 0.5% to 6.5% of individuals were reclassified,” said researcher Martin Willemink, MD, from University Medical Center Utrecht in the Netherlands.

Although a 6.5% reclassification rate might seem modest, “the absolute number of calcium-scoring CT scans is very large, especially since American Heart Association guidelines recommend calcium scoring for asymptomatic adults at low–intermediate and intermediate risk,” Dr. Willemink toldMedscape Medical News. This comprises approximately 40% of the population in the United States.

He presented the findings here at the European Congress of Radiology 2014.

The research team evaluated images from 15 ex vivo human hearts scanned with CT scanners from 4 vendors: GE Healthcare, Philips, Siemens, and Toshiba.

For each heart, an Agatston score was calculated using the software of the respective vendor. Calcium scoring protocols and radiation dose levels were similar for the 4 scanners.

“We found very large differences in Agatston scores for the same heart on different scanners,” he reported.

We found that calcium scores differed substantially among state-of-the-art CT systems from 4 major vendors.

The researchers then used the ex vivo Agatston scores to simulate the effects of the different scanners on 432 older people participating in the Rotterdam Study, a prospective population-based study.

All subjects had known Agatston scores and were classified as being at intermediate risk, Dr. Willemink explained. Linear regression analysis was used to obtain a conversion factor to compare scores from each scanner.

The largest variation in calcium score was between Siemens and GE Healthcare scanners, where median scores ranged from 332 to 469 (P < .05).

Dr. Willemink reported that “14 individuals who were initially classified by Siemens as low risk were reclassified as intermediate risk by another vendor, and another 14 were reclassified from intermediate to high risk.”

Table. Risk Classification of Patients by Scanner

Risk Category Siemens, n GE Healthcare, n
Low (calcium score <50) 196 182
High (calcium score >650) 70 84



“Theoretically, a subject could be classified as low risk at hospital A and not receive any therapy, and as high risk at hospital B and receive therapy,” he said. “The calcium scoring scan protocols should be adjusted so that different CT scanners result in similar calcium scores.”

The impact of these findings on individuals is potentially “dramatic,” noted Matthew Budoff, MD, professor of medicine at the Los Angeles Biomedical Research Institute and one of the authors of the 2010 AHA/ACCF Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults (J Am Coll Cardiol2010;56:e50-e103).

“I think the study presented is valid,” he told Medscape Medical News. However, it was primarily based on scans of ex vivo hearts and should be confirmed in live subjects. “We need in vivo data to prove there is a problem,” he said.

In addition, “the motion of the coronary arteries changes with heart rate changes; this was not taken into account because the hearts were not moving. With coronary motion in vivo, this may be an even bigger problem. It certainly suggests that, until more research is done, patients getting follow-up scans should get the scan done on similar equipment.”

Dr. Budoff was involved in a previous study of nearly 100 patients that found “very high concordance” among 3 scanners (J Comput Assist Tomogr2009;33:175-178). “Perhaps the newer scanners are not being well calibrated for coronary artery calcium scanning. There may be too much focus on new adaptations with CT scanners and the vendors might not be careful enough with calcium score results,” he said.

In fact, “this study has limited relevance in the current environment,” said Donald Lloyd-Jones, MD, professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago, who was speaking on behalf of the American Heart Association.

“Recent evidence-based recommendations from the American Heart Association/American College of Cardiology and from the Joint British Societies advise consideration of statin therapy for individuals at risk levels well below those evaluated by Dr. Willemink’s team,” Dr. Lloyd-Jones told Medscape Medical News. Therefore, “the issue of reclassification for the old intermediate-risk group is largely moot.”

Dr. Lloyd-Jones is a coauthor of the 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk (J Am Coll CardiolPublished online November 12, 2013).

But Dr. Budoff said he disagrees with Dr. Lloyd-Jones. “The new guidelines advocate for calcium scoring when risk ascertainment is uncertain with Framingham risk.”

“Whatever the risk cutpoint, we need a consistent result,” he said.