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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EParticular sections of the much anticipated 2013 American College of Cardiology (ACC)\/American Heart Association (AHA) cardiovascular (CV) prevention guidelines have received both applause and criticism. This article presents experts\u0027 views on a few of the more divisive recommendations.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EParticular sections of the much anticipated 2013 American College of Cardiology (ACC)\/American Heart Association (AHA) cardiovascular (CV) prevention guidelines have received both applause and criticism. In this session, several experts presented their views on a few of the more divisive recommendations.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOne controversial recommendation in both primary and secondary prevention in the 2013 Cholesterol Guidelines [Stone NJ et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013; \u003Cem\u003ECirculation\u003C\/em\u003E 2013] is the shift away from titrating drug therapy to specific low-density lipoprotein-cholesterol (LDL-C) targets as previously advocated. This change by the authors was based on review of the applicable clinical trials. For example, trials that have consistently demonstrated the efficacy and safety of statins in multiple patient populations have not tested strategies of titration to LDL (or other lipid marker) targets. These trials tested strategies of fixed-dose statin versus placebo, and later fixed-dose intensive versus standard statin therapy. In each comparison, the former demonstrated greater reductions in CV outcomes such as myocardial infarction, stroke, and CV death with minimal safety or tolerability concerns. Karol E. Watson, MD, PhD, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA, believes recommendations for a fixed-dose strategy are an improvement as the recommended treatment strategy is now tied directly to scientific evidence.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDr. Watson also agreed with the recommendation of medications proven to confer the greatest CV risk reduction. Consistent with the evidence, the guideline authors reviewed the available cholesterol therapies and found that statins resulted in risk reduction of major coronary events, coronary revascularization, stroke, and other major vascular events. In line with the evidence, statins should form the foundation of CV risk reduction by pharmacologic lipid-modifying therapy (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Kearney PM et al. \u003Cem\u003ELancet\u003C\/em\u003E 2008]. In fact, data supporting a clinical benefit for other lipid-modifying drugs is minimal.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15872\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15872\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15872\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EStatin Effects on Major Vascular Events\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EWhile the new guidelines recommend statin therapy in patients with a prior atherosclerotic event or diabetes, for those between the ages of 40 and 75 years with an LDL between 70 and 189 mg\/dL, they recommend use of a risk estimator to assess whether statin therapy would provide net benefit. For patients agedn \u0026lt;40 and \u0026gt;75 years without a history of diabetes or prior atherosclerotic event, the authors do not provide specific guidance as data in these groups are limited. In regards to the risk estimator, Dr. Watson applauded the guideline authors for expanding the risk estimator outcome to coronary heart disease (CHD) death, myocardial infarction (MI), and stroke (not just CHD and MI). The risk estimator now also considers gender, age, race, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure (BP), whether the patient is receiving BP treatment, and their diabetes and smoking status. It also provides information from ages 20 to 59 years on lifetime CV risk. Finally, the guideline authors encourage discussion between the clinician and patient regarding the potential risk reduction benefits and adverse effects of any therapy, drug-drug interactions, incorporation of other relevant information (eg, family history, coronary artery calcium [CAC] score), and patient preference.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EJames S. Forrester, MD, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA, believes that replacing the LDL target strategy with one based on fixed-dose statins is unwise as other lines of evidence (eg, genetic data) support a \u201clower is better\u201d approach to LDL management. Instead, Dr. Forrester recommends a hybrid of fixed statin dose and LDL target strategy as the best approach for prevention.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Forrester discussed two clinical studies that support increased efficacy with further LDL reduction. One suggested that the progression of atherosclerosis and the incidence of CHD events are minimized when LDL is lowered to \u0026lt;70 mg\/dL (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [O\u0027Keefe JH, Jr. et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2004]. The other, from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin study [JUPITER], indicated that participants attaining LDL-C \u0026lt;50 mg\/dL had an additional 21% absolute risk reduction in CV events rates compared with the entire study population. Decreases in LDL beyond prior targets also have not been consistently associated with safety or tolerability concerns [Hsia J et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Optimal LDL-C Level to Minimize Atherosclerosis Progression and Coronary Heart Events\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-176369793\u0022 data-figure-caption=\u0022Optimal LDL-C Level to Minimize Atherosclerosis Progression and Coronary Heart Events\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15866\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EOptimal LDL-C Level to Minimize Atherosclerosis Progression and Coronary Heart Events\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ELDL=low-density lipoprotein.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from O\u0027Keefe JH, Jr et al. Optimal low-density lipoprotein is 50 to 70 mg\/dl: lower is better and physiologically normal. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2004; 43(11):2142\u20132146. With permisison from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Forrester\u0027s second criticism is regarding the risk estimator in which age may be overemphasized, potentially resulting in missed opportunities to identify and modify coronary artery disease at younger ages and overstating the need to modify risk factors in \u201colder\u201d (\u0026gt;65 years) age. He cited studies demonstrating the early onset of atherosclerosis in Western societies. One study included 262 patients with heart transplants in which a monotonic progression of atheroma in the native coronary arteries related to patient age was found [Tuzcu EM et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2001]. The study indicated that by age 30 to 40 years, 50% to 60% of these individuals have atheroma. These data are supported by the Vietnam War study in which 45% of the 105 participants (mean age, 22 years) had arterial plaque [Joseph A et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 1993]. Finally, coronary artery calcium (CAC; a specific sign of atherosclerosis) has been found in 40% to 60% of individuals by age 45 years [Blaha MJ et al. \u003Cem\u003ECirc Cardiovasc Imaging\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EMichael J. Blaha, MD, MPH, Johns Hopkins University, Baltimore, Maryland, USA, sees clear forward steps in the prevention guidelines with the incorporation of race into the risk estimator, the inclusion of stroke into the composite outcome of the risk estimator, and the prioritization of statins. However, Dr. Blaha expressed concern about the validity of the risk estimator.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EDr. Blaha questioned whether the greater dependence on chronologic age in the new estimator provides any guidance with respect to prevention. The estimator calculates a \u0026gt;7.5% 10-year risk for patients with otherwise ideal parameters at approximately age 60 to 65 years in men and age 65 to 70 years in women. He also has concerns about the classification of patients with respect to risk, particularly those who might be at intermediate risk. Comparing Framingham Risk Score (FRS), to the new estimator would now classify significantly more patients previously considered \u201cintermediate risk\u201d as \u201chigh risk\u201d (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Dr. Blaha\u0027s concern with this shift is that it seems to imply more certainty with respect to classification, which in his opinion has not been validated. In addition, the risk estimator\u0027s dependence on age moves patients from intermediate to high risk based on age alone and more quickly (\u223c3 years vs \u223c8 years) than the FRS, a well-validated risk estimator. Dr. Blaha\u0027s final concern with the new risk estimator was a concern for poor calibration, or overestimation of predicted risk.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Relative Allocation of High, Intermediate*, and Low Risk Patients: FRS Versus 2013 AHA\/ACC Risk Estimator                    *                   Intermediate risk for the ATP4 estimator assumes a score of 5 to 7.5. ACC=American College of Cardiology; AHA=American Heart Association; CHD=coronary heart disease; CVD=cardiovascular disease.                             \u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-176369793\u0022 data-figure-caption=\u0022Relative Allocation of High, Intermediate*, and Low Risk Patients: FRS Versus 2013 AHA\/ACC Risk Estimator                    *                   Intermediate risk for the ATP4 estimator assumes a score of 5 to 7.5. ACC=American College of Cardiology; AHA=American Heart Association; CHD=coronary heart disease; CVD=cardiovascular disease.                             \u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15868\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ERelative Allocation of High, Intermediate\u003Ca id=\u0022xref-fn-1-1\u0022 class=\u0022xref-fn\u0022 href=\u0022#fn-1\u0022\u003E*\u003C\/a\u003E, and Low Risk Patients: FRS Versus 2013 AHA\/ACC Risk Estimator \n            \u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced with permission from MJ Blaha, MD, MPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EHarvey S. Hecht, MD, Mount Sinai Hospital, New York, New York, USA, discussed his concern that the 2013 guidelines have de-emphasized CAC in determination of who might be assigned statin therapy. Dr. Hecht believes that the evidence for the value of CAC in risk estimation is strong. He noted that numerous studies have demonstrated CAC to be an independent predictor of CV events. It holds a Class II (Level of Evidence A) recommendation in the 2010 ACCF\/AHA guideline for assessment of CV risk in asymptomatic adults [Greenland P et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2010; \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2010] and the 2012 European guidelines on CV disease prevention in clinical practice [Perk I et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. In addition, multiple studies have shown a direct relationship between patients knowing their CAC scan results and improved adherence to therapy [Youssef G et al. \u003Cem\u003ECurr Cardiol Rep\u003C\/em\u003E 2013; Orakzai RH et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2008; Taylor AJ et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008]. In one recent study, greater improvements in BP, LDL, waist size, weight, and FRS were found in patients with abnormal CAC scores, who were shown their results (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E) [Rozanski A et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15874\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15874\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15874\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EEffects of Coronary Artery Scanning on Outcomes in the EISNER Trial\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EConcerns that contributed to the authors lowering the recommendation for CAC were cost and increased potential radiation exposure. Dr. Hecht noted that the radiation level for CAC is now in the same range as mammography and decreasing. The cost has also dramatically decreased to about $100. While full consensus was not reached on the controversial topics discussed, the speakers appeared to agree that clinicians should not lose sight of the purpose of the guidelines, which is to guide decision-making, not mandate it.\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the American College of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-176369793\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the American College of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure3\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure3\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/4\/34\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15870\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the American College of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section fn-group\u0022 id=\u0022fn-group-1\u0022\u003E\u003Ch2\u003EArticle Notes\u003C\/h2\u003E\u003Cul\u003E\u003Cli class=\u0022fn-other\u0022 id=\u0022fn-1\u0022\u003E\n                  \n                  \u003Cp id=\u0022p-14\u0022\u003E\u003Ca class=\u0022rev-xref\u0022 href=\u0022#xref-fn-1-1\u0022\u003E\u21b5\u003C\/a\u003E\u003Cspan class=\u0022fn-label\u0022\u003E*\u003C\/span\u003E Intermediate risk for the ATP4 estimator assumes a score of 5 to 7.5. ACC=American College of Cardiology; AHA=American Heart Association; CHD=coronary heart disease; CVD=cardiovascular disease.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/4\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzpc6p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpc6p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzpc6p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}