This story hits almost all the high points we look for in a news report. It gives readers not only the basic summary of an analysis of how CT scan results showing levels of calcium deposits in coronary arteries are associated with 10-year rates of heart attacks and other cardiovascular disease, but it includes more than one skeptical voice and plainly discusses study limitations and potential harms. Still, our criteria are demanding, and the story falls a bit short on two points: disclosures of researcher relationships with industry and then alternatives available to people who might consider getting one of these scans. But the strengths of this story are an example of how to get it right.
Too often, stories about medical tests fall into the “why not” category. This story lays out the potential benefits reported by researchers, but it also provides readers clear and useful explanations of the nuances and potential pitfalls of this sort of CT scan. The story is important because the number of people placed on statins has progressively increased over the years — and if some people can avoid these drugs without putting themselves at increased risk, then it’s probably good that they avail themselves of the opportunity.
The story reports that a CT scan looking for calcium in coronary arteries “typically costs between $75 and $100. Still, it is generally not covered by insurance and so is not often used to assess risk.” That’s enough information to clear our bar handily, although we’d note that such scans can also turn up lung nodules that require additional follow-up and related costs.
The story reports that among study participants, those with a zero calcium score on a heart CT scan had only half the expected number of heart attacks or disabling chest pain over a 10-year period. That’s a relative comparison, which as we frequently note does not provide the full picture regarding benefit. But the story goes on to give readers a better sense of what these numbers mean in absolute terms. It explains the example of a person with a 12 percent risk of a heart attack over a decade based on the risk calculator recommended by the American college of Cardiology and others. That person actually turned out to have only a 4 percent 10-year risk, below the widely-used 7.5 percent risk threshold for recommending a statin.
The story makes clear that the scan does not provide a direct health benefit, but it provides information to people who are trying to decide about whether to start taking cholesterol-reducing statins. To help with that decision, it would have been nice for the story to include some discussion of the benefits associated with statin use, especially the numbers needed to treat (NNT) with a statin in order to save a life.
The story includes only one patient anecdote, a woman who was feeling depressed and had trouble getting out of bed when she took statins, and then decided to stop taking the drugs after having a CT scan that showed zero calcium. We often find fault with stories that introduce readers to only one patient, who claims to have greatly benefited; however, the placement of the anecdote low in the story and the preceding context that included limitations and expert cautions mean this single patient story doesn’t overwhelm the other information.
Link to online Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator: http://tools.acc.org/ASCVD-Risk-Estimator/
The story clearly lays out some of the ways that testing can go awry. It reports that the CT scans expose people to about the same amount of radiation as a mammogram, implying a level that many people routinely accept, though it does not go into detail about potential radiation effects. The story also explains the risk of “incidentalomas”, things that can pop up on this sort of scan besides coronary artery calcium, such as nodules in lungs, that might lead a person down a path of further testing and treatment. And it spells out the potential consequences of having a scan that reveals high levels of calcium deposits, prompting further testing and treatments, perhaps leading to substantial harms.Overall, we think the harms are admirably covered.
The story points out that the study was observational, “not the highest level of evidence”. It goes on to explain that since people in the study were not randomly assigned to testing or no testing, the results do not demonstrate that changing current practice would change real health outcomes.
The story reports that proponents are suggesting this sort of scan only for people who need more information to make a decision about statin treatment. It also includes skeptics who doubt the value of the test for most people. The tone is calm, not shrill. We saw no evidence of disease mongering.
This was a split decision that we ultimately ruled Not Satisfactory. There are multiple independent sources in the story, so it clearly addresses that element of the criterion. However, the story does not report the financial relationships some of the study authors have with manufacturers of scanners and other medical devices. One of our reviewers argued that these scanning machines are essentially generic and that therefore a conflict of interest disclosure is not relevant in this case. Two others voted that the potential conflict, minimal though it might be, was still directly relevant to the story and merited a brief mention. This is an instance where a binary Satisfactory/Not Satisfactory rating does not capture the nuance involved in our decision-making, which is why we always encourage readers to pay more attention to the comments than the ratings.
There is no mention of alternative risk calculators that include lifestyle and other factors, which people on the fence can use to help clarify their thinking about statin treatment. It also does not clearly point out that people who are uncertain about statin treatment can try the drug to see if they experience bothersome side effects. In other words, there are alternative ways for people to gather information that could help them decide about statin treatment.
The story makes clear that this test is readily available, and points out that it is generally not covered by insurance.
The story notes that CT scans for coronary artery calcium are not new, and that what is new is the analysis of how test scores are associated with 10-year rates of heart attacks and other cardiovascular disease.
The story clearly does not rely on a news release. There is original reporting that includes feedback from the original authors of the paper as well as independent experts.