Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland.
J Gen Intern Med. 2012 Feb;27(2):220-31. doi: 10.1007/s11606-011-1833-3. Epub 2011 Sep 1.
Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized.
We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes.
This study is a systematic review.
We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions.
We included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease.
We identified four randomized controlled trials (RCT, n=709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n=2,994). In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p=0.03) in one RCT. Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk. However, such data were conflicting and limited by the lack of a randomized control group. No studies examined the impact of screening on cardiovascular events or mortality. Heterogeneity in screening methods and studied outcomes did not permit pooling of results.
Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.
非侵入性动脉粥样硬化成像在临床实践中被越来越多地使用，一些专家建议对所有健康成年人进行动脉粥样硬化筛查，一些司法管辖区则要求为动脉粥样硬化筛查提供保险。但目前尚未系统地综合此类筛查的影响数据。
我们旨在评估动脉粥样硬化筛查是否能改善心血管风险因素（CVRF）和临床结局。
这是一项系统综述。
我们无语言限制地检索了 MEDLINE 和 Cochrane 临床试验登记处。
我们纳入了使用非侵入性成像（如颈动脉超声、冠状动脉钙化）检查动脉粥样硬化对无心血管疾病的成年人的 CVRF、心血管事件或死亡率影响的研究。
我们确定了四项随机对照试验（RCT，n=709）和八项比较筛查时发现有动脉粥样硬化证据与未发现有动脉粥样硬化证据的参与者（n=2994）的非随机研究。在 RCT 中，动脉粥样硬化筛查并未改善 CVRF，但一项 RCT 中戒烟率增加（18%比 6%，p=0.03）。非随机研究发现了一些中间结局的改善，例如改变生活方式的动力增加和对心血管风险的认知增加。然而，此类数据存在差异，且受到缺乏随机对照组的限制。没有研究评估筛查对心血管事件或死亡率的影响。由于筛查方法和研究结局的异质性，无法对结果进行合并。
目前关于动脉粥样硬化筛查的证据有限，对 CVRF 控制的结果喜忧参半，一项 RCT 中戒烟率增加，且无心血管事件数据。在广泛应用之前，此类筛查应通过大型临床试验进行验证。
