Rate of progression of coronary calcium by Electron Beam Tomography Budoff MJ, Lane Kl, Bakhsheshi H, Mao S, Grassmann BO, Friedman BC, Brundage BH  Div. of Cardiology, St John’s Cardiovascular Research Ctr, Harbor-UCLA Med.Ctr, Torrance, USA. American Journal of  Cardiology 2000;86(1):8-11

INTRODUCTION:  In this study, we sought to determine the rate of progression of atherosclerosis using coronary calcium scores derived from electron beam tomography (EBCT). We studied a variety of disease states (hypertension, high cholesterol, tobacco use, diabetes mellitus) followed for 1 to 6.5 years. We evaluated 299 asymptomatic persons (227 men and 72 women) who underwent 2 consecutive EBCT scans at least 12 months apart.  

RESULTS: 

Groups	% with Regression	% with Progression	Average annual increase in CAS
Without statin therapy	4 %	96 %	39  + 12%
With statin therapy	37 %	63 %	15 + 8%

The average change in the calcium score (Agatston method) for the entire group was 33.2 + 9.2% / year.

The relative increase in calcium scores did not vary significantly by gender or risk factors, with the exception of statin-treated hypercholesterolemic subjects. In patients undergoing treatment to lower cholesterol, 37% reduced their "calcification scores," versus a reduction in only 4% of the untreated group  In those whose coronary artery calcification had progressed, there was a 61% reduction in the rate of progression in those same patients when statin drugs were aggressively used to lower cholesterol in response to the demonstrated progression of their atherosclerosis.  Scores of zero on the initial scan portend a low likelihood of significant calcific deposits on repeat scanning.  Only 2 of 81 participants (2%) with scores of zero at baseline had scores >10 on repeat study. Those with calcium scores, and without effective intervention, might be expected to double their calcium score every 2.5 years

CONCLUSION:     Statin therapy induced a significant reduction in the rate of coronary calcium progression and even plaque regression.  This study demonstrates that EBCT may be a useful tool in assessing efficacy of different interventions to retard progression of atherosclerosis, noninvasively, over relatively short time periods.  

COMMENTS by Dr Budoff - The ability to track an individual's atherosclerotic burden non-invasively will provide physicians with a tool that has been missing in cardiology. Physicians can now assess whether a specific therapy is working, without waiting for obstructive heart disease, a heart attack or stroke to be proof of treatment failure. The clear demonstration of heart disease progression provided by the EBCT coronary artery scan has been proven to be an extremely effective and motivational patient compliance tool. There is nothing like visualizing the actual disease process.