The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review

Atherosclerosis. 2014 Oct;236(2):338-50. doi: 10.1016/j.atherosclerosis.2014.07.022. Epub 2014 Aug 1.


Objective: To perform systematic review of the effects of screening for coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), on behavioral or lifestyle modification, risk perception, and medication adherence.

Methods: We searched through CINAHL, PsychInfo, Web of Science, Cochrane Central Register of Control Trials, and PubMed (Medline) for studies on the effects of CAC screening in asymptomatic individuals across three major domains: behavioral modification, risk perception for CAD, and medication adherence. We extracted data from the retrieved studies, assessed and synthesized the information.

Results: Of the 15 retrieved studies, three were randomized control trials and 12 were observational studies. CAC score was ascertained either as total score, quartiles, or standardized Agatston's ordinal scale. While all the 15 studies involved issues related to behavioral and medication adherence, four involved risk perception of CAD. Although no standardized approach was used in these studies, CAC screening enhanced medication adherence in 13 of the 15 studies, while the others were mixed.

Conclusion: CAC screening improved medication adherence and could likely motivated individuals for beneficial behavioral or lifestyle changes to improve CAD. The mixed results suggest the need for further research because screening for subclinical atherosclerosis has significant implications for early detection and prevention of future cardiovascular events by aggressive risk factors modification.

Keywords: Computed tomography; Coronary artery calcium; Coronary artery disease; Lifestyle or behavioral modification; Medication adherence; Risk perception; Screening; Subclinical atherosclerosis; Subclinical markers.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Asymptomatic Diseases
  • Calcinosis / diagnostic imaging*
  • Calcinosis / psychology
  • Calcium / analysis*
  • Coronary Angiography / economics
  • Coronary Angiography / methods*
  • Coronary Angiography / psychology
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / epidemiology
  • Coronary Disease / psychology
  • Coronary Vessels / chemistry*
  • Cost-Benefit Analysis
  • Health Behavior*
  • Health Promotion
  • Humans
  • Life Style
  • Medication Adherence*
  • Middle Aged
  • Motivation
  • Observational Studies as Topic
  • Psychology
  • Randomized Controlled Trials as Topic
  • Research Design
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index*
  • Smoking Cessation / psychology
  • Tomography, X-Ray Computed / economics
  • Tomography, X-Ray Computed / methods*
  • Tomography, X-Ray Computed / psychology


  • Calcium