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Circ Cardiovasc Qual Outcomes. 2014 May;7(3):453-60. doi: 10.1161/CIRCOUTCOMES.113.000690. Epub 2014 May 6.

Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis.

Author information

1
From the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN (M.D.M.); Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, Boston, MA (M.D.M.); Cardiovascular Division, University of Minnesota, Minneapolis (D.A.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (J.R.M., A.R.F.); Ciccarone Preventive Cardiology Center, Johns Hopkins School of Medicine, Baltimore, MD (M.J.B., K.N., M.G.S.); Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL (K.N.); Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.); Department of Medicine, Herbert Wertheim College of Medicine, Miami, FL (K.N.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); and Department of Preventive Medicine (P.G.) and Department of Medicine (P.G.), Northwestern University Feinberg School of Medicine, Chicago, IL. mdm307@mail.harvard.edu.
2
From the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN (M.D.M.); Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, Boston, MA (M.D.M.); Cardiovascular Division, University of Minnesota, Minneapolis (D.A.D.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (J.R.M., A.R.F.); Ciccarone Preventive Cardiology Center, Johns Hopkins School of Medicine, Baltimore, MD (M.J.B., K.N., M.G.S.); Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL (K.N.); Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami (K.N.); Department of Medicine, Herbert Wertheim College of Medicine, Miami, FL (K.N.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); and Department of Preventive Medicine (P.G.) and Department of Medicine (P.G.), Northwestern University Feinberg School of Medicine, Chicago, IL.

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-to-treat 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 meta-analysis. Results were stratified by a 10% 10-year CHD Framingham Risk Score (FRS). Individuals with CAC≥100 had an estimated net benefit with aspirin regardless of their traditional risk status (estimated 5-year number needed to treat of 173 for individuals <10% 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.

KEYWORDS:

aspirin; coronary disease; prevention

PMID:
24803472
PMCID:
PMC4412344
DOI:
10.1161/CIRCOUTCOMES.113.000690
[Indexed for MEDLINE]
Free PMC Article

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