CAC severity IDs who will benefit most from statins

  • Mitchell JD & al.
  • J Am Coll Cardiol
  • 31 Oct 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Coronary artery calcium (CAC) score >100 identifies patients without atherosclerotic (AS) cardiovascular disease (CVD) who will benefit most from statins.
  • This group has reduced major adverse cardiac event (MACE) rates.
  • CAC of 0 tied to no benefit at 10 years of follow-up.

Why this matters

  • Editorial: “Authors clearly demonstrate the net value of statin benefit to be directly proportional to CAC AS disease.”
  • Following on these findings, the new cholesterol guidelines added CAC measurement to workup for patients with low-density lipoprotein ≥70-189 mg/dL + 10-year ASCVD risk ≥7.5%-19.9% to gauge need for statin (0, possibly no statin needed; 1-99, statins favored; ≥100 or ≥75th percentile, statins indicated).

Key results

  • MACE risk if CAC+, statin prescribed within 5 years:
    • Adjusted subHR: 0.76 (95% CI, 0.60-0.95; P=.015).
  • MACE with no CAC, statins prescribed:
    • Adjusted subHR: 1.00 (95% CI, 0.79-1.27; P=.99).
  • With statin use, number needed to treat to prevent 1 MACE in 10 years:
    • 100 with CAC 1-100 (P=.095).
    • 12 with CAC >100 (P<.0001>

Study design

  • 13,644 consecutive patients (mean age, 49.6±8.4 years; 71% men) without ASCVD having CAC scoring, 2002-2009 at Walter Reed Army Medical Center; median follow-up, 9.4 (interquartile range, 7.2-11.2) years.
  • Funding: NIH.

Limitations

  • Healthy user bias.
  • Retrospective.

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