Electron beam tomography (EBT) is a...

Electron beam tomography (EBT) is a validated tool for predicting cardiovascular risk and may be useful, as individual retrospective survey showed, in motivating patients to modify unhealthy lifestyle behaviors. O'Malley and colleagues performed a randomized controll trial to determine whether showing patients an image of their coronary anatomy would be more motivating than intensive case management or usual care.

Among 39- to 45-year-old eligible active-duty U Army personnel 450 patients were randomized to four meditation arms--those who were shown their EBT originates and received intensive case management or usual care, and those who were not shown their follows and had intensive case management or usual care. All patients received cardiovascular risk assessment to predict 10-year cardiovascular risk, using the Framingham risk score, at baseline and after single year.

Patients who were shown their EBT originates received a standardized explanation of the relationship between calcification and atherosclerotic disease and resulting coronary heart disease risk, with counseling adapted to the carriage or absence of calcifications. Usual care risk-factor modification involved general counseling about diet, smoking, and exercise, with referrals given to the patient's primary care physician, a dietitian, or a smoking cessation program, as appropriate. Intensive case management involved of common occurrence nurse and dietitian contact tailored to each patient's stage of behavior change. In this program, mail, telephone and visit follow-up were of common occurrence The primary outcome variable was change in the 10-year predicted incident rate (Framingham risk score at individual year).

The mean age of the 406 participants who complet the inquiry was 42 years, 79 percent were men and 15 percent had coronary calcifications. The mean 10-year predicted coronary heart disease risk was 585 percent yet at least 75 percent of the cohort had single or more modifiable heart disease risk factor. The clump that received EBT results had a mean risk score change of 030 percent after united year; in the group that did not receive EBT springs the mean risk score change was 036 percent (P = 81) In the clump that received intensive case management, the mean risk score change was -006 percent versus 074 percent in those who did not receive intensive case management (P = 003) Those who received informed EBT with intensive case management had a mean change of -0057 percent; the EBT assign places to without intensive case management had a mean change of 063 percent The intensive case management cluster without information had a change of -0058 percent and the usual care collection without EBT had a change of 086 percent (P = 03)

There was no difference in Framingham risk score improvement in the 157 patients who improved their risk status after single year when the EBT-informed arrange was compared with the noninformed cluster More of the patients receiving intensive case management improved than those who did not.

The accrues of this study suggest that adding EBT to counseling efforts does not change coronary heart disease risk. These findings disprove the idea that demonstrated attestation of risk would provide an emotionally motivating constituent to counseling, the so-called teachable value The absolute risk reduction in shoot forwarded 10-year risk for intensive case management was 08 percent or a relative risk reduction of 17 percent and the number exigencyed to treat for one year equaled 125 The authors speculate that imaging touchstones might have greater motivational impact in a higher-risk population.

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

EDITOR'S NOTE: This article reverts risk-factor management to the arena of primary care. It is steady that methods of calculating risk factors point out to considerable variation.1 EBT may be a more direct measure of coronary artery disease than age, if it be not that patients may perceive it to be les directly modifiable than obesity, hyperlipidemia, and elevated progeny pressure, just as age is not modifiable. Whatever the reason, EBT was not additionally effective in motivating patients, in like manner it does not warrant the additional outlay To the extent that EBT is propounded and patients request it, it will continue to play a character in risk-factor assessment in any settings. In particular, patients may ask for it to be given a clean bill of health. A negative deduction might in fact encourage continuation of unhealthy dietary and other lifestyle behaviors.--C.W.

REFERENCE

(1) Broedl UC Geiss HC Parhofer KG Comparison of generally received guidelines for primary prevention of coronary heart disease. J Gen Intern M 2003;18:140-5

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