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Eur J Prev Cardiol. 2018 Nov;25(17):1887-1898. doi: 10.1177/2047487318788930. Epub 2018 Jul 25.

Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study.

Author information

1
1 Preventive Medicine Center Hospital, Israelita Albert Einstein and School of Medicine, Brazil.
2
2 Center for Clinical and Epidemiological Research, University of São Paulo, Brazil.
3
3 Cardiovascular Imaging Program, Brigham and Women's Hospital and Harvard Medical School, USA.
4
4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, USA.
5
5 National Institutes of Health, USA.
6
6 Center for Prevention and Wellness Research, Baptist Health Medical Group, USA.
7
7 Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, USA.
8
8 Section of Cardiovascular Medicine and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, USA.
9
9 Section of Health Policy and Administration, Yale School of Public Health, USA.
10
10 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.

Abstract

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 lipid-lowering 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.

KEYWORDS:

Cardiovascular disease; coronary artery calcium; primary prevention; risk stratification

PMID:
30043629
DOI:
10.1177/2047487318788930
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