Although many clinicians and patients have been embracing the “Got Plaque? Get a CAC!” strategy to “Go Beyond the Risk Calculator” and make more nuanced decisions regarding the danger of one’s Lipid Neighborhood, there are still some haters out there. Interestingly, many of these haters are more than willing to sell you their program, agenda, and several-thousand-dollar workup instead of ordering you a CAC, but I’m sure that’s merely coincidence.
But recently, some preliminary results from the CorCal Outcomes Trial were presented at the European Society of Cardiology Congress, and the CAC-Attackers immediately latched on to that study with leech-like fervor, jubilantly proclaiming that “CAC is Trash!” despite the litany of evidence suggesting otherwise.
Here is what we currently know about this study:
- 5772 patients, 51% women, mean age 64 without known cardiovascular disease were enrolled and followed for 4.2 years.
- The study compared whether statin initiation based on the patient’s CAC measurement could reduce cardiovascular events vs. traditional risk factor-based assessment (Simply put, this is CAC vs Risk Calculators, which have, time and time again, been pretty abysmal compared to CAC, which you can read about HERE and HERE).
- After 4.2 years, there was no difference in major adverse cardiovascular events (MACE) between the groups, although those in the CAC group were MUCH MORE ADHERENT to the medication advice given by their clinician (62%) vs the Risk Calculator group (23%). Event rates were quite low in both groups.
So I could reiterate a bunch of stuff I’ve said before about the utility of CAC, understanding the usefulness of blood-based biomarkers, and basically everything I’ve said in THIS BOOK, but instead, I think it would be pertinent to discuss the OXFORD COMMA.
Some have decried the Oxford Comma, or Serial Comma, as superfluous, unnecessary and redundant, although I would argue that it can be useful, beneficial, and even essential (see what I did there)? You may need to re-read that last sentence again!
Now, is the Oxford Comma always necessary when writing out three or more terms in a list? No. But omitting the Oxford Comma resulted in a multimillion dollar lawsuit in THIS CASE, and depending on the context, eliminating the penultimate comma in a series can change the interpretation of a sentence. For instance:
With the Oxford Comma:
I invited the kids next door, Clarence, and Doris.
Without the Oxford Comma:
I invited the kids next door, Clarence and Doris.
WHOA! Obviously Clarence and Doris are sweet grandparents in their mid-80s, but WITHOUT the Oxford Comma, you might be led to believe that the parents of the neighbor kids went “Extreme Vintage Retro” with their children’s names!
So should we completely eliminate both Oxford Comma and the use of CAC? Well, if you have a better Cardiovascular Risk Stratification solution for the kids, Elmer, and Doris, then by all means😊
