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Calcium Scans Shown to Be Effective for Heart Disease Screening

By MedImaging International staff writers
Posted on 19 Oct 2009

A simple, noninvasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death. Coronary artery calcium scans can be performed without triggering excessive additional testing and costs, according to recent findings.

Findings from the multicenter EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study, led by investigators from the Cedars-Sinai Heart Institute (Los Angeles, CA, USA), was published in the September 29, 2009, issue of the Journal of the American College of Cardiology.

Coronary artery calcium scans using coronary computed tomographic angiography (CCTA) that detect plaque in the coronary arteries have been shown to be more effective than standard cholesterol and blood pressure measurements in identifying patients who are most vulnerable to heart disease. Currently, these scans are not covered by private insurance carriers in the United States, in part because of concerns that detection of low levels of cardiovascular disease will result in unnecessary and expensive additional testing, including exercise imaging and invasive cardiac catheterization procedures.

"Over half of patients who suffer heart attacks have no warning that they have heart disease until the heart attack occurs. If we knew the patients were at risk, current treatments could prevent the majority of these unnecessary events. We had to address the concerns about unnecessary testing and costs related to this potentially lifesaving procedure,” said Daniel S. Berman, M.D., the study's lead investigator and chief of Cardiac Imaging at Cedars-Sinai's S. Mark Taper Foundation Imaging Center in Los Angeles.

In the EISNER study, supported by The Eisner Foundation (Los Angeles, CA, USA), researchers performed coronary calcium scans on 1,361 volunteers at intermediate risk for coronary artery disease, and followed them over a four-year period, from May 2001 to June 2005. The objective was to determine the relationship between coronary artery calcium scores and subsequent cardiac events and to evaluate the performance of additional cardiac diagnostic testing. Coronary artery calcium scores of 0 indicate no plaque, 1-9 minimal, 10-99 mild, 100-399 moderate, 400-999 extensive, and 1,000 or more very extensive plaque.

Coronary artery calcium scores varied widely but the vast majority of the patients had low scores. More than half --56.7% of subjects--had scores of less than 10, and only 8.2% had scores higher than 400. There was a strong relationship between the coronary calcium scores and subsequent cardiac events. The unique finding of the EISNER study was that there was a marked difference in the number, type, and frequency of medical tests and costs given a subject's coronary artery calcium score.

Additional stress testing was infrequent and related costs were low among subjects with low coronary artery calcium scores. Both rose progressively as the coronary artery calcium score increased, particularly in the patients at highest risk--those with scores of greater than 1,000--found in only 2.2% of subjects (31). Importantly, catheter-based invasive coronary angiography was performed exclusively among subjects with high coronary artery calcium scores. Even then, only 19.4% of participants who were in the highest risk category underwent this expensive procedure associated with a small but definite risk.

Recent evidence has demonstrated that screening with coronary artery calcium is a better prognosticator of risk than the Framingham Risk Score--the traditional way of assessing risk based on blood testing and blood pressure--in middle aged and elderly patients. Yet, controversy surrounds expansion of cardiac screening to include coronary calcium scanning imaging because of concerns that the extra costs may not outweigh the benefits. The findings of the EISNER study, the researchers noted, is the first direct evidence that coronary artery calcium scanning could be an acceptable cost-effective screening test for coronary artery disease, since it is able to identify high risk subgroups in need of aggressive medical treatment, and patients who undergo additional testing constitute only a small fraction of the screened population.

Leslee J. Shaw, M.D., from the Emory University School of Medicine (Atlanta, GA, USA) and one of the investigators of the trial, has received grant support from GE Healthcare [Chalfont St. Giles, UK]; one of the imaging machines used in the study);

Related Links:
Cedars-Sinai Heart Institute
GE Healthcare

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60 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

61 (!!!!! 4552.1259307861): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (590.08598327637): SELECT fid FROM jos_deeppockets WHERE id=294726040 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726040 AND published='1' LIMIT 1

63 (!!!!! 1631.9751739502): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (!!!!! 1787.1856689453): select jos_twitters.link from jos_twitters where cat=10

65 (279.18815612793): select jos_facebook.link from jos_facebook where cat=10

66 (187.15858459473): select jos_google_plus.link from jos_google_plus where cat=10

67 (173.80714416504): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 6597.9957580566): SELECT fid FROM jos_deeppockets WHERE id=294726040 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726040 AND published='1' LIMIT 1

69 (231.02760314941): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (479.93659973145): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 1585.0067138672): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1227.855682373): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (205.03997802734): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 1201.1528015137): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (48.87580871582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (33.855438232422): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

105 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

106 (52.928924560547): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.206878662109): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (149.01161193848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

109 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

110 (62.942504882812): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (501.87110900879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (694.99015808105): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (484.94338989258): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (183.8207244873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

115 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

116 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

117 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

118 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

119 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

120 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

122 (375.03242492676): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 49892.18711853): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 2027.0347595215): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726040 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726040 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 18491.983413696): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (228.8818359375): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (298.97689819336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (190.01960754395): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (244.8558807373): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (277.04238891602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (!!!!! 1266.0026550293): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (255.82313537598): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (225.06713867188): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (241.04118347168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (691.89071655273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (454.90264892578): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (283.00285339355): SELECT name FROM jos_deeppockets WHERE id=211

138 (123.97766113281): SELECT name FROM jos_deeppockets WHERE id=211

139 (598.90747070312): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (579.833984375): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

143 (!!!!! 12372.016906738): TRUNCATE TABLE jos_trademed_module

144 (121.8318939209): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (73.909759521484): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726040 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1159.9063873291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (568.86672973633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

149 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

150 (!!!!! 1950.0255584717): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (325.91819763184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

152 (126.12342834473): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

153 (71.048736572266): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726040 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726040 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (129.93812561035): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (33.140182495117): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (622.03407287598): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

158 (149.96528625488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726040 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726040 AND published='1' LIMIT 1

159 (!!!!! 3036.0221862793): select jos_twitters.link from jos_twitters where cat=10

160 (113.01040649414): select jos_facebook.link from jos_facebook where cat=10

161 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

162 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

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