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And yet, although randomized trials show that CAC scores predict CV outcomes when CAC is measured in healthy individuals, patients, and transplanted hearts, investigators do not routinely measure CAC in these populations. 532586 Instead, they measure CAC in subsets of patients who have most risk of CV events, such as those with diabetes. This defeats the purpose of assessing CV risk because it excludes patients who are not a risk for adverse CV events, it does not appropriately risk-stratify patients, and it fails to differentiate those with and without atherosclerosis at the early stages when treatment modalities are more likely to prevent CV events. Thus, CAC scores are a waste of time and money, a result of misdirected resources.
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In contrast, definitive imaging endpoints such as carotid plaque and coronary calcium score, which are used to detect coronary atherosclerosis, are reported in a smaller number of CVOTs for SGLT-2Is. It appears that the PRIDE study (Program on Research for Intensive Care in Diabetes) may be the largest study reporting CAC and plaque deposition (Table 3 and 4). 149 Among patients who underwent both CAC and coronary calcium score at baseline, coronary calcium score was reduced by 0.50 (P
Next, when choosing the most appropriate questionnaire, be familiar with the questionnaire. 279 A good score is probably not one that is a perfect number, but one that is within the acceptable range of the questionnaire. 280