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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.

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

European journal of preventive cardiology. 2018;(17):1887-1898
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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.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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