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Master of Public Health

Relation of Absence of Coronary Artery Calcium to Cardiovascular Disease Mortality Risk among Individuals Meeting Criteria for Statin Therapy According to the 2018/2019 ACC/AHA Guidelines

AUTHORS

Rajan T , Rozanski A , Cainzos-Achirica M , Grandhi GR , Dardari ZA , Al-Mallah MH , Blankstein R , Miedema MD , Shaw LJ , Rumberger JA , Budoff MJ , Blaha MJ , Berman D , Nasir K , . The American journal of cardiology. 2020 9 14; ().

ABSTRACT

The 2013 ACC/AHA guidelines resulted in broad recommendations for preventive statin therapy allocation among individuals without known cardiovascular disease (CVD). Subsequent studies demonstrated significant heterogeneity of atherosclerotic cardiovascular disease (ASCVD) risk across the primary prevention population. In 2018/2019, the guidelines were revised to optimize risk assessment and cholesterol management. We sought to evaluate the heterogeneity of risk among statin-recommended individuals, using coronary artery calcium (CAC) according to 2018/2019 ACC/AHA guidelines in a primary prevention cohort. We evaluated 5,800 statin-naive individuals aged 40-75 years without known coronary heart disease (CHD) from the Cedars-Sinai Medical Center study cohort. All participants underwent clinical CAC scoring for risk stratification and were followed for all-cause and CVD-specific mortality. A total of 181 deaths occurred including 54 CVD deaths over a follow-up of 9.5 years. Overall, 1,939 participants would have been recommended statin therapy, 32% of whom had no detectable CAC. CAC=0 participants had the lowest all-cause and CVD mortality rates in both statin-recommended and non-recommended groups (0.2 and 0.4 CVD deaths per 1,000 person-years, respectively). Absence of CAC in statin-naive patients portends an approximately twelve-fold lower CVD mortality (0.2% vs 2.4%) among those recommended for statin therapy compared to any CAC present. In conclusion, among a cohort of patients meeting the 2018/2019 ACC/AHA guidelines for statin therapy for primary prevention, there was a marked heterogeneity of CAC scores, with about one-third of the statin recommended population having no detectable CAC (CAC=0) with a significantly lower CVD mortality compared to CAC>0.

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