Review The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: A systematic review Hadii M. Mamudu a, * , Timir K. Paul b, 1 , Sreenivas P. Veeranki c, 2 , Matthew Budoff d, 3 a Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, S. Dossett Drive, Lamb Hall, P.O. Box 70264, Johnson City, TN 37614, USA b Division of Cardiology, James H. Quillen College of Medicine, East Tennessee State University,1123 Waterbrooke Lane, Johnson City, TN 37604, USA c Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA d Los Angeles Biomedical Research Institute,1124 W Carson Street, Torrance, CA 90502, USA article info Article history: Received 20 June 2014 Received in revised form 21 July 2014 Accepted 21 July 2014 Available online 1 August 2014 Keywords: Coronary artery calcium Coronary artery disease Subclinical markers Subclinical atherosclerosis Computed tomography Screening Lifestyle or behavioral modification Risk perception Medication adherence abstract 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 adher- ence. 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. Published by Elsevier Ireland Ltd. Contents 1. Introduction ...................................................................................................................... 339 2. Methods ......................................................................................................................... 339 2.1. Literature search and selection ................................................................................................ 339 2.2. Data extraction .............................................................................................................. 339 2.3. Quality appraisal ............................................................................................................ 340 2.4. Data synthesis ............................................................................................................... 340 3. Results .................................................................. ........................................................ 340 3.1. Characteristics of eligible CAC studies .......................................................................................... 340 3.2. Types of studies ............................................................................................................. 340 * Corresponding author. Tel.: þ1 423 439 4484; fax: þ1 423 439 6710. E-mail addresses: mamudu@etsu.edu, hadiious@gmail.com (H.M. Mamudu), pault@mail.etsu.edu (T.K. Paul), drveeranki@gmail.com (S.P. Veeranki), mbudoff@labiomed. org (M. Budoff). 1 Tel.: þ1 423 979 4106; fax: þ1 423 979 4134. 2 Tel.: þ1 615 936 3531; fax: þ1 615 343 6249. 3 Tel.: þ1 310 222 4107; fax: þ1 310 782 9652. Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis http://dx.doi.org/10.1016/j.atherosclerosis.2014.07.022 0021-9150/Published by Elsevier Ireland Ltd. Atherosclerosis 236 (2014) 338e350