TY - JOUR
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
N1 - Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KN is on the advisory board for Quest Diagnostic. RB serves on a scientific advisory board for Amgen Inc. and receives research support from Amgen Inc. and Gilead Inc. MJB is on the speaker’s bureau for General Electric. HMK is the recipient of a research grant from Medtronic, Inc. through Yale University and is chair of a cardiac scientific advisory board for UnitedHealth. MSB has received research funding from Sanofi and speaker fees from Boston Scientific. No other potential conflicts of interest relevant to this article were reported.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169 from the National Heart, Lung, and Blood Institute, by grants UL1-TR-000040, UL1-TR-001079, UL1-TR-001420 from NCATS.
Publisher Copyright:
© The European Society of Cardiology 2018.
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 lipidlowering 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 lipidlowering 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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U2 - 10.1177/2047487318788930
DO - 10.1177/2047487318788930
M3 - Article
C2 - 30043629
AN - SCOPUS:85052245012
SN - 2047-4873
VL - 25
SP - 1887
EP - 1898
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 17
ER -