Coronary artery calcium and carotid artery intima-media thickness for the prediction of stroke and benefit from statins

Kazuhiro Osawa, Maria Esther Perez Trejo, Rine Nakanishi, Robyn L. McClelland, Michael J. Blaha, Ron Blankstein, John W. McEvoy, Indre Ceponiene, James H. Stein, Ralph L. Sacco, Joseph F. Polak, Matthew J. Budoff

Research output: Contribution to journalArticle

Abstract

Background: Current guidelines suggest treatment for many individuals who may never develop a stroke. We hypothesized that a combination of coronary artery calcification (CAC) and carotid artery intima-media thickness (CIMT) data could better individualize risk assessment for ischemic stroke and transient ischemic attack events. Methods: A total of 4720 individuals from the Multi-Ethnic Study of Atherosclerosis were evaluated for ischemic stroke and transient ischemic attack. Cox proportional hazards models for time to incident ischemic stroke/transient ischemic attack were used to examine CAC and CIMT as ischemic stroke/transient ischemic attack predictors in addition to traditional risk factors. We calculated the 10-year number needed to treat by applying the benefit observed in ASCOT-LLA to the observed event rates within CAC and CIMT strata. Results: Median follow-up was 13.1 years. Compared with individuals with no CAC and with CIMT ≤ 75th percentile, stroke/transient ischemic attack risk increased progressively with each CAC category (0, 1–100, >100) among individuals with CIMT > 75th percentile. Among participants eligible for statin therapy based on the 2013 atherosclerotic cardiovascular disease (ASCVD) guidelines (ASCVD risk of >5%), 739/2906 (25%) had no CAC and CIMT ≤ 75th percentile and an observed ischemic stroke/transient ischemic attack rate of 2.49 per 1000 person-years. The predicted 10-year number needed to treat was 292 for no CAC and CIMT ≤ 75th percentile and 57 for CAC > 100 and CIMT > 75th percentile. Conclusion: The combination of CIMT and CAC could serve to further refine risk calculation for ischemic stroke/transient ischemic attack prevention and may prioritize those in most need of statin therapy to reduce ischemic stroke/transient ischemic attack risk.

Original languageEnglish (US)
Pages (from-to)1980-1987
Number of pages8
JournalEuropean Journal of Preventive Cardiology
Volume25
Issue number18
DOIs
StatePublished - Dec 1 2018

Keywords

  • Carotid artery intima-media thickness
  • coronary artery calcification
  • ischemic stroke/transient ischemic attack

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

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    Osawa, K., Trejo, M. E. P., Nakanishi, R., McClelland, R. L., Blaha, M. J., Blankstein, R., McEvoy, J. W., Ceponiene, I., Stein, J. H., Sacco, R. L., Polak, J. F., & Budoff, M. J. (2018). Coronary artery calcium and carotid artery intima-media thickness for the prediction of stroke and benefit from statins. European Journal of Preventive Cardiology, 25(18), 1980-1987. https://doi.org/10.1177/2047487318798058