Abstract 3839: Does Screening for Coronary Calcium “Change Management”? Statin and Aspirin Use over 6-Years in the PACC Project
Objectives: Whether the detection of coronary artery calcium (CAC) leads to changes in cardiovascular risk management is unproven. We examined statin and aspirin (ASA) usage in a community-based cohort following cardiovascular risk and CAC screening to determine if CAC, a marker of increased CHD risk, was independently associated with greater use of these preventive therapies.
Methods: 1640 men, aged 40–50 yrs, without known CHD, were screened for CHD risk factors and CAC using EBCT. During up to 6 years of prospective annual structured telephone contacts, we observed subsequent ’ever use’ and ’consistent use’ of daily ASA and statins using logistic regression to control for CAC, baseline medication use, and NCEP risk variables.
Results: Overall, 22.4% had CAC detected on EBCT at baseline, and, at study entry, the proportion of participants using either a statin or ASA was approximately 2-fold greater among those with CAC (9.9% vs 4.7%, P < .001). During follow-up the use of both ASA and statins increased progressively, but by 6 years statin use was 3x more likely among those with CAC (48.5% vs 15.5%, P < .001) and ASA use was nearly twice as likely (53.0% vs. 32.3% P < .01). The appropriateness of statin use was also related to the presence of CAC such that, among participants not treated with statins at baseline, the incidence of new statin use was more than 2x greater among participants with CAC who were not at NCEP LDL goal at baseline (n = 469), and more than 4x greater among participants with an LDL below the NCEP goal at baseline. Multiple logistic regression controlling for NCEP risk variables showed that CAC was independently associated with a significantly higher likelihood of ’ever use’ of statin (OR 3.5, P < .001), ASA (OR 3.0, P < .001) and both ASA and statin together (OR 7.0, P < .001). However, ’consistent use’ of either ASA or a statin was unrelated to CAC after controlling for demographic, behavioral, psychological and NCEP variables.
Conclusions: The detection of CAC is associated with an independent 3 to 7-fold greater likelihood of treatment with statins and/or aspirin, but not consistent use of either medication. CAC screening leads to initiation of preventive therapies, but additional interventions are likely required to maintain therapeutic persistence.