Coronary artery calcium presence associated with ASCVD events
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The presence of coronary artery calcium among individuals with risk-enhancing factors was associated with increased atherosclerotic CVD events, exceeding the threshold for statin therapy initiation, researchers reported.
“Despite an increased risk of short-term ASCVD events among those with vs. without risk-enhancing factors, data suggest that certain risk-enhancing factors (family history of premature ASCVD, dyslipidemia, diabetes and metabolic syndrome) are frequently associated with low short-term rates of ASCVD events among those with CAC scores of 0,” Jaideep Patel, MD, cardiology fellow at Pauley Heart Center at Virginia Commonwealth University Medical Center, and researcher at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, and colleagues wrote in JAMA Cardiology.
The multicenter, population-based, prospective cross-sectional study included 1,688 participants (mean age, 65 years; 58% men) aged 45 to 75 years with no baseline clinical ASCVD or diabetes who were at intermediate risk for ASCVD with LDL levels of 70 mg/dL to 189 mg/dL. Baseline data were obtained between July 2000 and July 2002 with follow-up data for incident ASCVD events obtained through August 2015.
The primary outcome was incident ASCVD during a median follow-up of 12 years.
There was a CAC score of 0 in 42.8% of participants. In addition, the prevalence of a CAC score of 0 was 45.7% among participants with one to two risk-enhancing factors compared with 40.3% among participants with three or more factors (P = .11).
Among participants with a score of 0, the unadjusted incidence rate of ASCVD was less than 7.5 per 1,000 person-years for all individual and combined risk-enhancing factors. Researchers observed the highest ASCVD incidence rates among those who experienced premature menopause, with 10.3 events per 1,000 person-years, and those with low ankle-brachial index, with 10.4 events per 1,000 person-years.
Among all risk-enhancing factors, use of CAC scoring was associated the greatest improvement in the C statistic for ASCVD events when added to traditional risk factors (0.633 vs. 0.678). The individual and composite additions of all risk-enhancing factors improved the area under the receiver operating curve compared with traditional risk factors alone, Patel and colleagues wrote.
“The use of CAC scoring was associated with significant improvements in the reclassification and discrimination of incident ASCVD and may therefore be useful as an adjunct to risk-enhancing factors to identify individuals with intermediate risk of ASCVD who would benefit from statin therapy,” the researchers wrote.
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