TY - JOUR
T1 - Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring
AU - Mitchell, Joshua D.
AU - Fergestrom, Nicole
AU - Gage, Brian F.
AU - Paisley, Robert
AU - Moon, Patrick
AU - Novak, Eric
AU - Cheezum, Michael
AU - Shaw, Leslee J.
AU - Villines, Todd C.
N1 - Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/12/25
Y1 - 2018/12/25
N2 - Background: Compared with traditional risk factors, coronary artery calcium (CAC) scores improve prognostic accuracy for atherosclerotic cardiovascular disease (ASCVD) outcomes. However, the relative impact of statins on ASCVD outcomes stratified by CAC scores is unknown. Objectives: The authors sought to determine whether CAC can identify patients most likely to benefit from statin treatment. Methods: The authors identified consecutive subjects without pre-existing ASCVD or malignancy who underwent CAC scoring from 2002 to 2009 at Walter Reed Army Medical Center. The primary outcome was first major adverse cardiovascular event (MACE), a composite of acute myocardial infarction, stroke, and cardiovascular death. The effect of statin therapy on outcomes was analyzed stratified by CAC presence and severity, after adjusting for baseline comorbidities with inverse probability of treatment weights based on propensity scores. Results: A total of 13,644 patients (mean age 50 years; 71% men) were followed for a median of 9.4 years. Comparing patients with and without statin exposure, statin therapy was associated with reduced risk of MACE in patients with CAC (adjusted subhazard ratio: 0.76; 95% confidence interval: 0.60 to 0.95; p = 0.015), but not in patients without CAC (adjusted subhazard ratio: 1.00; 95% confidence interval: 0.79 to 1.27; p = 0.99). The effect of statin use on MACE was significantly related to the severity of CAC (p < 0.0001 for interaction), with the number needed to treat to prevent 1 initial MACE outcome over 10 years ranging from 100 (CAC 1 to 100) to 12 (CAC >100). Conclusions: In a largescale cohort without baseline ASCVD, the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases.
AB - Background: Compared with traditional risk factors, coronary artery calcium (CAC) scores improve prognostic accuracy for atherosclerotic cardiovascular disease (ASCVD) outcomes. However, the relative impact of statins on ASCVD outcomes stratified by CAC scores is unknown. Objectives: The authors sought to determine whether CAC can identify patients most likely to benefit from statin treatment. Methods: The authors identified consecutive subjects without pre-existing ASCVD or malignancy who underwent CAC scoring from 2002 to 2009 at Walter Reed Army Medical Center. The primary outcome was first major adverse cardiovascular event (MACE), a composite of acute myocardial infarction, stroke, and cardiovascular death. The effect of statin therapy on outcomes was analyzed stratified by CAC presence and severity, after adjusting for baseline comorbidities with inverse probability of treatment weights based on propensity scores. Results: A total of 13,644 patients (mean age 50 years; 71% men) were followed for a median of 9.4 years. Comparing patients with and without statin exposure, statin therapy was associated with reduced risk of MACE in patients with CAC (adjusted subhazard ratio: 0.76; 95% confidence interval: 0.60 to 0.95; p = 0.015), but not in patients without CAC (adjusted subhazard ratio: 1.00; 95% confidence interval: 0.79 to 1.27; p = 0.99). The effect of statin use on MACE was significantly related to the severity of CAC (p < 0.0001 for interaction), with the number needed to treat to prevent 1 initial MACE outcome over 10 years ranging from 100 (CAC 1 to 100) to 12 (CAC >100). Conclusions: In a largescale cohort without baseline ASCVD, the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases.
KW - atherosclerotic cardiovascular disease
KW - calcium score
KW - cardiovascular risk
KW - primary prevention
KW - screening
UR - http://www.scopus.com/inward/record.url?scp=85058439569&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2018.09.051
DO - 10.1016/j.jacc.2018.09.051
M3 - Article
C2 - 30409567
AN - SCOPUS:85058439569
SN - 0735-1097
VL - 72
SP - 3233
EP - 3242
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -