Abstract 12825: Association between hsCRP≥2, Coronary Artery Calcium, and Adverse Events - Implications for the JUPITER Population: Multi-Ethnic Study of Atherosclerosis (MESA)
Background: The JUPITER trial demonstrated that some patients with LDL less than 130 mg/dL and hsCRP >=2 mg/L benefit from rosuvastatin. We sought to determine whether coronary artery calcium (CAC) may identify a subgroup of the JUPITER population expected to derive the most benefit.
Methods: MESA is a longitudinal, population-based study of 6,814 men and women aged 45–84 free of clinical CVD at enrollment. A total of 3,258 participants met the following JUPITER entry criteria: LDL less than 130, no lipid-lowering therapy, and no diabetes. Of these, 1,451 had hsCRP >=2, and were thus similar to the JUPITER population. To determine if CAC can further risk stratify, we compared CHD and CVD event rates and multivariable-adjusted hazard ratios after stratifying by both presence and burden of CAC (0, 1–100, >100). In addition, we calculated 5-year NNTs by applying the hazard ratio from JUPITER to the event rates observed within each CAC strata.
Results: Mean follow-up was 5.5 ± 1.0 years. In total, 59% of the JUPITER-like population had CAC=0. CHD event rates in this group were less than 1 event per 1000 person-years. There was a graded increase in events with increasing CAC score. Approximately 2/3 of all events occurred in the 15% of patients with CAC >100, at a rate of 19 per 1000 person-years. After multivariable adjustment, presence of CAC in the JUPITER-like population was associated with a 9.7-fold increased risk of a CHD event. For CHD, the estimated 5-year NNT for CAC 0, 1–100, and >100 was 714, 106, and 25 respectively. For CVD, the respective 5-year NNTs were 177, 57, and 20.
Conclusion: Within MESA, a majority of JUPITER-like participants had CAC=0 and experienced an extremely low event rate. Most events occurred in the small group of patients with CAC>100. This suggests that CAC may be used to target a subgroup of asymptomatic patients fitting JUPITER criteria that may derive the most benefit from statin therapy. Notably, CAC also predicts events well in patients with LDL <130 and hsCRP <2.
- © 2010 by American Heart Association, Inc.