Calcium score: what do the most reliable guidelines recommend? An analysis using the G-TRUST tool

Area of Science:

• Cardiology
• Preventive Medicine
• Health Policy

Background:

• Cardiovascular disease (CVD) remains the leading global cause of death.
• Clinical practice guidelines (CPGs) offer varying recommendations on using the coronary calcium score (CSC) for individual cardiovascular risk assessment.
• Lack of consensus necessitates evaluating the reliability of CPGs regarding CSC use in primary prevention.

Purpose of the Study:

• To assess the reliability and relevance of CPGs concerning the use of CSC in primary prevention of cardiovascular disease.
• To identify which CPGs provide trustworthy recommendations on CSC utilization for risk stratification.

Main Methods:

• A systematic search of PubMed identified CPGs published between 2018-2023 addressing CSC use in primary prevention.
• The G-TRUST evaluation grid was employed to assess the quality and reliability of the selected CPGs.
• CPGs were categorized as 'reliable and relevant' or 'not usable' based on predefined criteria.

Main Results:

• Out of 467 publications, only seven CPGs met the inclusion criteria for the study.
• Only two of the seven CPGs were deemed 'reliable and relevant' by the G-TRUST assessment.
• The remaining five CPGs were classified as 'not usable' due to conflicts of interest, lack of systematic reviews, or absence of patient input.

Conclusions:

• The two reliable CPGs concluded that the CSC should not be used for cardiovascular risk assessment in primary prevention.
• Conversely, the five CPGs deemed 'not usable' recommended the use of CSC.
• The G-TRUST tool effectively evaluates the methodological quality of recommendations, distinguishing reliable guidelines from less dependable ones.