Dyslipidemia, Coronary Artery Calcium, and Incident Atherosclerotic Cardiovascular Disease: Implications for Statin Therapy from the Multi-Ethnic Study of Atherosclerosis
Background—Worldwide clinical practice guidelines for dyslipidemia emphasize allocating statin therapy to those at the highest absolute atherosclerotic cardiovascular disease (CVD) risk.
Methods and Results—We examined 5,534 MESA participants who were not on baseline medications for dyslipidemia. Participants were classified by baseline CAC score (>0, >=100) and the common clinical scheme of counting lipid abnormalities (LA), including LDL-C >=3.36 mmol/L (130 mg/dL), HDL-C <1.03 mmol/L (40 mg/dL) for men or <1.29 mmol/L (50 mg/dL) for women, and triglycerides >=1.69 mmol/L (150 mg/dL). Our main outcome measure was incident CVD (myocardial infarction, angina resulting in revascularization, resuscitated cardiac arrest, stroke, cardiovascular death). Over a median follow-up of 7.6 years, more than half of events (55%) occurred in the 21% of participants with CAC>=100. Conversely, 65% of events occurred in participants with zero or one LA. In those with CAC>=100, CVD rates ranged from 22.2 to 29.2 per 1,000 person-years across LA categories. In contrast, with CAC=0, CVD rates ranged from 2.4 to 6.2 per 1,000 person-years across LA categories. Individuals with zero LA and CAC>=100 had a higher event rate compared to individuals with three LA but CAC=0 (22.2 vs 6.2 per 1,000 person-years). Similar results were obtained when classifying LA using dataset-quartiles of TC/HDL-C, LDL-C, non-HDL-C, or LDL particle concentration and guideline-categories of LDL-C or non-HDL-C.
Conclusions—CAC may have the potential to help match statin therapy to absolute CVD risk. Across the spectrum of dyslipidemia, event rates similar to secondary prevention populations were observed for patients with CAC>=100.
- Received May 8, 2013.
- Revision received August 23, 2013.
- Accepted September 17, 2013.