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J Am Coll Cardiol. 2015 Oct 13;66(15):1657-68. doi: 10.1016/j.jacc.2015.07.066.

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis).

Author information

  • 1Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. Electronic address: KhurramN@baptisthealth.net.
  • 2Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Preventive Medicine Centre, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • 3The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
  • 4Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
  • 5Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida.
  • 6Mount Sinai Hospital, Miami Beach, Florida.
  • 7Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
  • 8Knight Cardiovascular Institute, Oregon Health & Science University, Portland Oregon.
  • 9Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, Georgia.
  • 10Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
  • 11Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.

Erratum in

  • J Am Coll Cardiol. Dec 15;66(23):2686. Miemdema, Michael D [corrected to Miedema, Michael D].

Abstract

BACKGROUND:

The American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines have significantly broadened the scope of candidates eligible for statin therapy.

OBJECTIVES:

This study evaluated the implications of the absence of coronary artery calcium (CAC) in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not.

METHODS:

MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6,814 men and women 45 to 84 years of age without clinical atherosclerotic cardiovascular disease (ASCVD) risk at enrollment. We excluded 1,100 participants (16%) on lipid-lowering medication, 87 (1.3%) without low-density lipoprotein levels, 26 (0.4%) with missing risk factors for calculation of 10-year risk of ASCVD, 633 (9%) >75 years of age, and 209 (3%) with low-density lipoprotein <70 mg/dl from the analysis.

RESULTS:

The study population consisted of 4,758 participants (age 59 ± 9 years; 47% males). A total of 247 (5.2%) ASCVD and 155 (3.3%) hard coronary heart disease events occurred over a median (interquartile range) follow-up of 10.3 (9.7 to 10.8) years. The new ACC/AHA guidelines recommended 2,377 (50%) MESA participants for moderate- to high-intensity statins; the majority (77%) was eligible because of a 10-year estimated ASCVD risk ≥7.5%. Of those recommended statins, 41% had CAC = 0 and had 5.2 ASCVD events/1,000 person-years. Among 589 participants (12%) considered for moderate-intensity statin, 338 (57%) had a CAC = 0, with an ASCVD event rate of 1.5 per 1,000 person-years. Of participants eligible (recommended or considered) for statins, 44% (1,316 of 2,966) had CAC = 0 at baseline and an observed 10-year ASCVD event rate of 4.2 per 1,000 person-years.

CONCLUSIONS:

Significant ASCVD risk heterogeneity exists among those eligible for statins according to the new guidelines. The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy.

Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

atherosclerosis; cholesterol; hydroxymethylglutaryl-CoA reductase inhibitors; risk assessment

PMID:
26449135
[PubMed - indexed for MEDLINE]
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