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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.

Keywords

Cardiovascular disease coronary artery calcium risk stratification primary prevention

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References

Catapano

Graham

De Backer

et al.

2016 ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Developed with the special contribution of the European Assocciation for Cardiovascular Prevention and Rehabilitation (EACPR). Atherosclerosis 2016; 253: 281–344.

Piepoli

Hoes

Agewall

et al.

2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381.

Nasir

Bittencourt

Blaha

et al.

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). J Am Coll Cardiol 2015; 66: 1657–1668.

Mahabadi

Mohlenkamp

Lehmann

. Heinz Nixdorf Recall Study Investigators. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. JACC Cardiovasc Imaging 2017; 10: 143–153.

Bild

Bluemke

Burke

et al.

Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 2002; 156: 871–881.

Carr

Nelson

Wong

et al.

Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) study. Radiology 2005; 234: 35–43.

Agatston

Janowitz

Hildner

et al.

Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.

Budoff

McClelland

Chung

et al.

Reproducibility of coronary artery calcified plaque with cardiac 64-MDCT: the Multi-Ethnic Study of Atherosclerosis. AJR Am J Roentgenol 2009; 192: 613–617.

Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, Wood AM, Lewington S, Sattar N, Packard CJ, Collins R, Thompson SG, Danesh J. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993–2000.

10.

Altman

Andersen

. Calculating the number needed to treat for trials where the outcome is time to an event. BMJ 1999; 319: 1492–1495.

11.

Detrano

Guerci

Carr

et al.

Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358: 1336–1345.

12.

Erbel

Moehlenkamp

Moebus

et al. Heinz Nixdorf Recall Study Investigators . Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 2010; 56: 1397–1406.

13.

Silverman

Blaha

Krumholz

et al.

Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J 2014; 35: 2232–2241.

14.

Pencina

Navar-Boggan

D'Agostino

Sr. et al.

Application of new cholesterol guidelines to a population-based sample. N Engl J Med 2014; 370: 1422–1431.

15.

DeFilippis

Young

McEvoy

et al.

Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association–American College of Cardiology – atherosclerotic cardiovascular disease risk score in a modern multi-ethnic cohort. Eur Heart J 2017; 38: 598–608.

16.

Yeboah

McClelland

Polonsky

et al.

Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA 2012; 308: 788–795.

17.

Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2016; 133: 849–858.

18.

Hecht

Blaha

Berman

et al.

Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2017; 11: 157–168.

19.

Braber

Mosterd

Prakken

et al.

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: the Measuring Athlete's Risk of Cardiovascular Events (MARC) study. Eur J Prev Cardiol 2016; 23: 1677–1684.

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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

Abstract

Aims

Methods and results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material