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)

Khurram Nasir, Marcio S. Bittencourt, Michael J. Blaha, Ron Blankstein, Arthur S. Agatson, Juan J. Rivera, Michael D. Miemdema, Christopher T. Sibley, Leslee J. Shaw, Roger S. Blumenthal, Matthew J. Budoff, Harlan M. Krumholz

Research output: Contribution to journalArticle

230 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1657-1668
Number of pages12
JournalJournal of the American College of Cardiology
Volume66
Issue number15
DOIs
StatePublished - Oct 13 2015

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of '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)'. Together they form a unique fingerprint.

  • Cite this

    Nasir, K., Bittencourt, M. S., Blaha, M. J., Blankstein, R., Agatson, A. S., Rivera, J. J., Miemdema, M. D., Sibley, C. T., Shaw, L. J., Blumenthal, R. S., Budoff, M. J., & Krumholz, H. M. (2015). 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). Journal of the American College of Cardiology, 66(15), 1657-1668. https://doi.org/10.1016/j.jacc.2015.07.066