Abstract 13148: Combined Association of Conventional Cardiovascular Risk Profile and Coronary Artery Calcium Score (CAC) With Cardiovascular Risk and CAC Progression: The St Francis Heart Study
Objective: Both coronary artery calcium (CAC) and clinical risk profile (RP) predict cardiovascular (CV) risk. Little is known about the association of combined CAC and RP with risk of CV outcomes and CAC progression.
Methods: We followed 1,225 asymptomatic adults from the observational arm of the St Francis Heart Study for a median of 3.9 years. Participants were categorized into four groups based on CAC and RP (using 2013 AHA guidelines for statin eligibility): group 1 (N=336) CAC<80th percentile (for age and gender), statin not indicated; group 2 (N=350) CAC<80th percentile, statin indicated; group 3 (N=209) CAC≥80th percentile, statin not indicated and group 4 (N=330) CAC≥80th percentile, statin indicated. We compared the risk among groups for a composite CV outcome that included non-fatal MI, coronary death, coronary revascularization, stroke and peripheral arterial revascularization. We also examined the association of groups with CAC progression at four years from baseline.
Results: Mean age was 59±6 years. Those eligible for statin were older (61±5 vs 55±5 years) and more likely to be male (82% vs.51%) than those not eligible. Median [IQR] CAC was higher in statin eligible than in noneligible subjects, 0 [0-7] vs. 9 [0-54] for groups 1 and 2 and 210 [115-404] vs. 482 [257-837] for groups 3 and 4. Adjusted hazard ratio (95% CI) for the composite CV outcome was 6.9 (0.8-58.9), 15.2 (1.9-119.3), and 37.8 (4.8-297.2) for groups 2, 3 and 4, respectively compared to group 1. There was a higher progression of CAC from baseline to year 4 among group 3 (median: 210 to 350) and group 4 (482 to 822) compared to group 1 (0 to 3) and group 2 (9 to 16), P<0.001.
Conclusion: While higher CAC is associated with greater CV outcome risk and CAC progression, statin therapy eligibility is associated with a higher CV outcome risk both among those with and without elevated CAC. Our findings suggest that RP remains important and should not be overlooked when CAC testing is used.
Author Disclosures: S. Waheed: None. N. Reichek: None. A. Guerci: None. J.J. Cao: None.
- © 2015 by American Heart Association, Inc.