CAC scoring helps identify which CVD patients will benefit from statin therapy: JAMA

USA: CT coronary artery calcium (CAC) scoring can be used as an adjunct to risk-enhancing factor assessment to allow the health professionals to confirm more accurately whether a patient is at moderate risk for atherosclerotic cardiovascular disease (ASCVD) would benefit from statin therapy, suggests a study published JAMA Cardiology journal.

According to the results from the cross-sectional study, in people with coronary artery calcium (CAC) scores of 0, the presence of risk-enhancing factors did not lead to overall atherosclerotic cardiovascular disease (ASCVD) risk that was higher than the recommended treatment threshold for the initiation of statin therapy. The use of calcium scores significantly improved reclassification and discrimination of incident ASCVD.

The 2018 guideline by the American Heart Association/American College of Cardiology on the management of blood cholesterol recommends the use of risk-enhancing factor assessment and the selective use of CAC scoring to guide statin treatment among people with an intermediate risk of ASCVD. Considering this, Jaideep Patel, Virginia Commonwealth University Medical Center, Richmond, and colleagues aimed to examine the association between risk-enhancing factors and incident ASCVD by CAC burden among those at intermediate risk of ASCVD in the Multi-Ethnic Study of Atherosclerosis -- a multicenter population-based prospective cross-sectional study conducted in the US.

For this purpose, the researchers collected baseline data between July 15, 2000, and July 14, 2002, and ascertained follow-up for incident ASCVD events through August 20, 2015. It included patients aged 45 to 75 years with no clinical ASCVD or diabetes at baseline, were at intermediate risk of ASCVD (≥7.5% to <20.0%), and had a low-density lipoprotein cholesterol level of 70 to 189 mg/dL.

A total of 1688 participants (mean age, 65 years; 57.8% were men). A total of 722 participants (42.8%) had a CAC score of 0. 

The results of our study support the utility of CAC scoring as an adjunct to risk-enhancing factor assessment to more accurately classify individuals with an intermediate risk of ASCVD who might benefit from statin therapy, the authors concluded.

Reference:

The study titled, "Assessment of Coronary Artery Calcium Scoring to Guide Statin Therapy Allocation According to Risk-Enhancing Factors: The Multi-Ethnic Study of Atherosclerosis," is published in the journal JAMA Cardiology.

DOI: https://jamanetwork.com/journals/jamacardiology/article-abstract/2781973