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J Am Coll Cardiol. 2018 Dec 25;72(25):3233-3242. doi: 10.1016/j.jacc.2018.09.051.

Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring.

Author information

1
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. Electronic address: jdmitchell@wustl.edu.
2
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri.
4
General Internal Medicine Section, Baylor College of Medicine, Houston, Texas.
5
Internal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
6
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
7
Cardiology Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia.
8
Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia. Electronic address: https://twitter.com/lesleejshaw.
9
Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.

Abstract

BACKGROUND:

Compared with traditional risk factors, coronary artery calcium (CAC) scores improve prognostic accuracy for atherosclerotic cardiovascular disease (ASCVD) outcomes. However, the relative impact of statins on ASCVD outcomes stratified by CAC scores is unknown.

OBJECTIVES:

The authors sought to determine whether CAC can identify patients most likely to benefit from statin treatment.

METHODS:

The authors identified consecutive subjects without pre-existing ASCVD or malignancy who underwent CAC scoring from 2002 to 2009 at Walter Reed Army Medical Center. The primary outcome was first major adverse cardiovascular event (MACE), a composite of acute myocardial infarction, stroke, and cardiovascular death. The effect of statin therapy on outcomes was analyzed stratified by CAC presence and severity, after adjusting for baseline comorbidities with inverse probability of treatment weights based on propensity scores.

RESULTS:

A total of 13,644 patients (mean age 50 years; 71% men) were followed for a median of 9.4 years. Comparing patients with and without statin exposure, statin therapy was associated with reduced risk of MACE in patients with CAC (adjusted subhazard ratio: 0.76; 95% confidence interval: 0.60 to 0.95; p = 0.015), but not in patients without CAC (adjusted subhazard ratio: 1.00; 95% confidence interval: 0.79 to 1.27; p = 0.99). The effect of statin use on MACE was significantly related to the severity of CAC (p < 0.0001 for interaction), with the number needed to treat to prevent 1 initial MACE outcome over 10 years ranging from 100 (CAC 1 to 100) to 12 (CAC >100).

CONCLUSIONS:

In a largescale cohort without baseline ASCVD, the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases.

KEYWORDS:

atherosclerotic cardiovascular disease; calcium score; cardiovascular risk; primary prevention; screening

PMID:
30409567
PMCID:
PMC6309473
[Available on 2019-12-25]
DOI:
10.1016/j.jacc.2018.09.051

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