Dr Robert Bonow (Northwestern University, Chicago, IL), past president of the AHA, who was also quoted in the WSJ story, told heartwire that the statement was commissioned by the AHA to compare the technical details of two imaging technologies currently used for coronary calcium scanning, electron beam tomography (EBT) and multidetector computed tomography (MDCT), and was not meant to be a practice guideline.

The thrust of the planned article was to explain the differences between the two technologies, he said: MDCT is performed using a scanner that is more widely available, for example, but most of the evidence generated on the accuracy of coronary calcium scoring to date has used EBT, Bonow noted.

"It wasn't an attempt to endorse or change our position on thisin fact the AHA doesn't endorse devices or scanners or equipment or drugs; we're not in the endorsing business," he said.

"With all of that confusion now being out there in the press, we were concerned that coming up with a publication may muddy the waters further," he said. Instead, Loscalzo and others will be writing an editorial to outline these events and to discuss the journal's embargo policy and prepublication use of information.

"Media attention can cause some harm," Bonow said. "Just today, I received a letter from a physician who is trying to sell me previously owned EBCT scanners. And he's basing this letter, which is clearly being written to many other people besides myself, on the fact that the AHA is now endorsing this product."

Rather than cause further confusion, he said, the decision was made not to publish the statement now but to take the technical components of it and publish them as part of an upcoming planned statement on CT scanners.

Beyond the science, the AHA statement raises the issue of embargo policy in this case. "Circulation is concerned about the sanctity of embargoed information to be published in the journal and the importance of not releasing embargoed information until the article is ready to be published," the release notes. "When individuals provide information to the media in advance of statement publication, there is risk that the individuals' perspective on an issue may influence the coverage of that issue and may not accurately reflect the synthesized message intended by the statement."

The WSJ article was written by veteran reporter Ron Winslow, a previous winner of the AHA's Howard L Lewis Award for career achievement in health reporting.

In his article, which appeared in the September 21, 2004 issue, Winslow writes, "Heart scans, the popular but controversial tests that link heart-attack risk to an accumulation of calcium in the coronary arteries, are poised to win an endorsement from the American Heart Association, which has long been skeptical of their value. Within the next few weeks, the influential organization is planning to publish a scientific statement that will say the tests can help doctors predict which patients are at risk of future heart attacks and decide how aggressively to treat those in danger.

"The guidelines are expected to apply specifically to patients at 'intermediate' risk of a heart attack based on their cholesterol levels, blood pressure, age, and health habits," Winslow adds. "Though it stops well short of supporting widespread screening, the documentexpected to be published in the next few weeks in Circulation: Journal of the American Heart Associationis likely to spark wider use of the exams and, possibly, improved reimbursement by insurers."

In the article, Winslow quotes Bonow and Dr Matthew J Budoff (Harbor-University of California, Los Angeles Medical Center), who was head of the writing committee for the statement, among others. "The science has come a long way," since the previous AHA statement on this subject in 2000, Budoff said. [That previous statement bitterly divided the writing committee at the timesee the heartwire report; link below.]

Bonow said that the decision not to publish the statement is not meant as a reprimand for the authors quoted in the story, because it's not clear to them where the conclusion that the upcoming statement would support use of the test came from. "It may or may not have been anybody on the committee," he said.

"We certainly appreciate all the effort that's gone into this, and the work that's been done is not going to be lost, because there will be a way of incorporating this in another paper that's already been commissioned, on CT scanning in the coronary arteries," he said.

Bonow was quoted in the story saying that he does order coronary calcium scanning in certain cases, but he made the point that it's not clear that the test will change outcomes. "I guess if I knew what it was going to come out looking like in print, I would have pointed out at that time that that was not the purpose of the paper," Bonow said.

Contacted by heartwire, Winslow declined to comment on this development.

However, it might be difficult for writing-committee members not to feel there is a message for them here about talking to the media. Blumenthal denied any of the panel members broke the embargo on the screening statement but pointed out, "When the last statement on coronary calcium came out in 2000, the head of that committee talked about what was in the article with members of the press before it was published."

"All of us on the writing group spent a large amount of time on this project," he told heartwire. "We had meetings at prior AHA [conferences], several long calls, and hundreds of emails. The AHA thought this topic was important enough for many of us to get together and devote large amounts of time to compile the latest data on EBT vs MDCT imaging of the heart. There was no sense doing this if the statement did not summarize when the test should be considered."