Use of coronary artery calcium testing to guide aspirin utilization for primary prevention

Estimates from the multi-ethnic study of atherosclerosis

Michael D. Miedema, Daniel A. Duprez, Jeffrey R. Misialek, Michael Blaha, Khurram Nasir, Michael G. Silverman, Ron Blankstein, Matthew J. Budoff, Philip Greenland, Aaron R. Folsom

Research output: Contribution to journalArticle

Abstract

Background-Aspirin for the primary prevention of coronary heart disease (CHD) is only recommended for individuals at high risk for CHD although the majority of CHD events occur in individuals who are at low to intermediate risk. Methods and Results-To estimate the potential of coronary artery calcium (CAC) scoring to guide aspirin use for primary prevention of CHD, we studied 4229 participants from the Multi-Ethnic Study of Atherosclerosis who were not on aspirin at baseline and were free of diabetes mellitus. Using data from median 7.6-year follow-up, 5-year number-needed-totreat estimations were calculated by applying an 18% relative CHD reduction to the observed event rates. This was contrasted to 5-year number-needed-to-harm estimations based on the risk of major bleeding reported in an aspirin metaanalysis. Results were stratified by a 10% 10-year CHD Framingham Risk Score (FRS). Individuals with CAC10% FRS and 92 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Conversely, individuals with zero CAC had unfavorable estimations (estimated 5-year number needed to treat of 2036 for individuals >10% FRS and 808 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Sex-specific and age-stratified analyses showed similar results. Conclusions-For the primary prevention of CHD, Multi-Ethnic Study of Atherosclerosis participants with CAC=100 had favorable risk/benefit estimations for aspirin use while participants with zero CAC were estimated to receive net harm from aspirin.

Original languageEnglish (US)
Pages (from-to)453-460
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Primary Prevention
Aspirin
Atherosclerosis
Coronary Vessels
Coronary Disease
Calcium
Numbers Needed To Treat
Diabetes Mellitus
Hemorrhage

Keywords

  • Aspirin
  • Coronary disease
  • Prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Use of coronary artery calcium testing to guide aspirin utilization for primary prevention : Estimates from the multi-ethnic study of atherosclerosis. / Miedema, Michael D.; Duprez, Daniel A.; Misialek, Jeffrey R.; Blaha, Michael; Nasir, Khurram; Silverman, Michael G.; Blankstein, Ron; Budoff, Matthew J.; Greenland, Philip; Folsom, Aaron R.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 7, No. 3, 2014, p. 453-460.

Research output: Contribution to journalArticle

Miedema, Michael D. ; Duprez, Daniel A. ; Misialek, Jeffrey R. ; Blaha, Michael ; Nasir, Khurram ; Silverman, Michael G. ; Blankstein, Ron ; Budoff, Matthew J. ; Greenland, Philip ; Folsom, Aaron R. / Use of coronary artery calcium testing to guide aspirin utilization for primary prevention : Estimates from the multi-ethnic study of atherosclerosis. In: Circulation: Cardiovascular Quality and Outcomes. 2014 ; Vol. 7, No. 3. pp. 453-460.
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AU - Blaha, Michael

AU - Nasir, Khurram

AU - Silverman, Michael G.

AU - Blankstein, Ron

AU - Budoff, Matthew J.

AU - Greenland, Philip

AU - Folsom, Aaron R.

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N2 - Background-Aspirin for the primary prevention of coronary heart disease (CHD) is only recommended for individuals at high risk for CHD although the majority of CHD events occur in individuals who are at low to intermediate risk. Methods and Results-To estimate the potential of coronary artery calcium (CAC) scoring to guide aspirin use for primary prevention of CHD, we studied 4229 participants from the Multi-Ethnic Study of Atherosclerosis who were not on aspirin at baseline and were free of diabetes mellitus. Using data from median 7.6-year follow-up, 5-year number-needed-totreat estimations were calculated by applying an 18% relative CHD reduction to the observed event rates. This was contrasted to 5-year number-needed-to-harm estimations based on the risk of major bleeding reported in an aspirin metaanalysis. Results were stratified by a 10% 10-year CHD Framingham Risk Score (FRS). Individuals with CAC10% FRS and 92 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Conversely, individuals with zero CAC had unfavorable estimations (estimated 5-year number needed to treat of 2036 for individuals >10% FRS and 808 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Sex-specific and age-stratified analyses showed similar results. Conclusions-For the primary prevention of CHD, Multi-Ethnic Study of Atherosclerosis participants with CAC=100 had favorable risk/benefit estimations for aspirin use while participants with zero CAC were estimated to receive net harm from aspirin.

AB - Background-Aspirin for the primary prevention of coronary heart disease (CHD) is only recommended for individuals at high risk for CHD although the majority of CHD events occur in individuals who are at low to intermediate risk. Methods and Results-To estimate the potential of coronary artery calcium (CAC) scoring to guide aspirin use for primary prevention of CHD, we studied 4229 participants from the Multi-Ethnic Study of Atherosclerosis who were not on aspirin at baseline and were free of diabetes mellitus. Using data from median 7.6-year follow-up, 5-year number-needed-totreat estimations were calculated by applying an 18% relative CHD reduction to the observed event rates. This was contrasted to 5-year number-needed-to-harm estimations based on the risk of major bleeding reported in an aspirin metaanalysis. Results were stratified by a 10% 10-year CHD Framingham Risk Score (FRS). Individuals with CAC10% FRS and 92 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Conversely, individuals with zero CAC had unfavorable estimations (estimated 5-year number needed to treat of 2036 for individuals >10% FRS and 808 for individuals =10% FRS, estimated 5-year number needed to harm of 442 for a major bleed). Sex-specific and age-stratified analyses showed similar results. Conclusions-For the primary prevention of CHD, Multi-Ethnic Study of Atherosclerosis participants with CAC=100 had favorable risk/benefit estimations for aspirin use while participants with zero CAC were estimated to receive net harm from aspirin.

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