Abstract 14763: Implications of Coronary Artery Calcium on Risk Stratification of Subjects With Indication for Lipid Lowering Therapy According to the European Society of Cardiology Recommendations - The Mesa Study
Introduction: The European guidelines for statin recommendation are based on different risk estimation and drug prescription strategies than the U.S. guidelines, and they currently do not recommend the use of coronary artery calcium (CAC) as part of the risk stratification.
Hypothesis: CAC will improve reclassification of individuals evaluated by the European guidelines risk score (SCORE).
Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6,814 men and women 45 to 84 years of age without clinical atherosclerotic cardiovascular disease (CVD) risk at enrollment. We excluded 1,103 individuals on lipid-lowering medication, those with missing total cholesterol or risk factors for calculation of the 10-year risk of hard CVD according to the SCORE. We evaluated the observed event rates according to SCORE risk and categories of CAC.
Results: The study population consisted of 5,711 participants (age 61±10years; 47%males). A total of 129 (2.3%) CV deaths, 361 (6.3%) hard CVD and 223 (3.9%) hard coronary heart disease events occurred over a median follow-up of 10.3 years. The European guidelines recommended statins in 1,693 (30%) participants and indicated that statins should be considered in 1688 (30%). The absence of CAC occurred in 74% of those with no statin recommendation, 48% of those in whom statins should be considered, and in 31% of those in whom statins are recommended. The rate of events stratified by statin indication according to the SCORE classification is presented in the figure.
Conclusions: The absence of CAC occurs in approximately 50% of individuals considered for statins and in approximately one third of individuals in whom statins are recommended. In both groups the absence of CAC is associated with substantially lower event rates. Thus, the use of CAC may improve the selection of candidates for statins among those who are recommended or considered for such therapies by the European guidelines for primary prevention.
Author Disclosures: M.S. Bittencourt: None. R. Blankstein: None. M.J. Blaha: None. V. Sandfort: None. A. Agatston: None. M. Budoff: None. R.S. Blumenthal: None. H. Krumholz: None. K. Nasir: None.
- © 2016 by American Heart Association, Inc.