Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study

Marcio S. Bittencourt, Ron Blankstein, Michael J. Blaha, Veit Sandfort, Arthur S. Agatston, Matthew J. Budoff, Roger S. Blumenthal, Harlan M. Krumholz, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Aims: The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results: We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N = 2228), consider lipid-lowering treatment if uncontrolled (N = 1686), or lipid-lowering treatment recommended (N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1–100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). Conclusion: The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.

Original languageEnglish (US)
JournalEuropean Journal of Preventive Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Coronary Vessels
Calcium
Lipids
Therapeutics
Mortality
Cardiology
Coronary Disease
Guidelines

Keywords

  • Cardiovascular disease
  • coronary artery calcium
  • primary prevention
  • risk stratification

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

Cite this

Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations : The MESA study. / Bittencourt, Marcio S.; Blankstein, Ron; Blaha, Michael J.; Sandfort, Veit; Agatston, Arthur S.; Budoff, Matthew J.; Blumenthal, Roger S.; Krumholz, Harlan M.; Nasir, Khurram.

In: European Journal of Preventive Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study",
abstract = "Aims: The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results: We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N = 2228), consider lipid-lowering treatment if uncontrolled (N = 1686), or lipid-lowering treatment recommended (N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54{\%} had coronary artery calcium of zero, 25{\%} had coronary artery calcium of 1–100 and 21{\%} had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31{\%} had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50{\%} had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7{\%}/10 years in the lipid-lowering treatment if uncontrolled, and 7.0{\%}/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4{\%}/10 years in the lipid-lowering treatment if uncontrolled group and 3.0{\%}/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0{\%}/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2{\%}/10 years). Conclusion: The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.",
keywords = "Cardiovascular disease, coronary artery calcium, primary prevention, risk stratification",
author = "Bittencourt, {Marcio S.} and Ron Blankstein and Blaha, {Michael J.} and Veit Sandfort and Agatston, {Arthur S.} and Budoff, {Matthew J.} and Blumenthal, {Roger S.} and Krumholz, {Harlan M.} and Khurram Nasir",
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T1 - Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations

T2 - The MESA study

AU - Bittencourt, Marcio S.

AU - Blankstein, Ron

AU - Blaha, Michael J.

AU - Sandfort, Veit

AU - Agatston, Arthur S.

AU - Budoff, Matthew J.

AU - Blumenthal, Roger S.

AU - Krumholz, Harlan M.

AU - Nasir, Khurram

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Aims: The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results: We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N = 2228), consider lipid-lowering treatment if uncontrolled (N = 1686), or lipid-lowering treatment recommended (N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1–100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). Conclusion: The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.

AB - Aims: The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results: We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N = 2228), consider lipid-lowering treatment if uncontrolled (N = 1686), or lipid-lowering treatment recommended (N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1–100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). Conclusion: The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.

KW - Cardiovascular disease

KW - coronary artery calcium

KW - primary prevention

KW - risk stratification

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