The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies A Systematic Review and Meta-Analysis

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author GUPTA, Ankur
LAU, Emily
VARSHNEY, Ravi
HULTEN, Edward A.
CHEEZUM, Michael
BITTENCOURT, Marcio S. FMUSP-HC
BLAHA, Michael J.
WONG, Nathan D.
BLUMENTHAL, Roger S.
BUDOFF, Matthew J.
UMSCHEID, Craig A.
NASIR, Khurram
BLANKSTEIN, Ron
dc.date.issued 2017
dc.identifier.citation JACC-CARDIOVASCULAR IMAGING, v.10, n.8, p.833-842, 2017
dc.identifier.issn 1936-878X
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/22211
dc.description.abstract OBJECTIVES The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography. BACKGROUND Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies. METHODS We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model. RESULTS After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure-lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure-lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors. CONCLUSIONS This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease. (C) 2017 by the American College of Cardiology Foundation.
dc.description.sponsorship · National Institutes of Health [5T32HL094301-07]
· National Institutes of Health
· General Electric
· Regeneron
· Quest Diagnostics
dc.language.iso eng
dc.publisher ELSEVIER SCIENCE INC
dc.relation.ispartof Jacc-Cardiovascular Imaging
dc.rights restrictedAccess
dc.subject cardiovascular prevention; coronary calcium score; meta-analysis
dc.subject.other beam computed-tomography; artery calcium; atherosclerosis mesa; risk-assessment; ct angiography; statin; management; adherence; trial; behaviors
dc.title The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies A Systematic Review and Meta-Analysis
dc.type article
dc.rights.holder Copyright ELSEVIER SCIENCE INC
dc.identifier.doi 10.1016/j.jcmg.2017.01.030
dc.identifier.pmid 28797402
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author BITTENCOURT, Marcio S.:HU:SCPACEX-62
hcfmusp.author.external · GUPTA, Ankur:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA
· LAU, Emily:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA
· VARSHNEY, Ravi:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA
· HULTEN, Edward A.:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA; Walter Reed Natl Mil Med Ctr, Washington, DC USA
· CHEEZUM, Michael:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA; Ft Belvoir Community Hosp, Ft Belvoir, VA USA
· BLAHA, Michael J.:John Hopkins Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA
· WONG, Nathan D.:Univ Calif Irvine, Irvine, CA USA
· BLUMENTHAL, Roger S.:John Hopkins Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA
· BUDOFF, Matthew J.:Harbor Univ Calif Los Angeles, Torrance, CA USA
· UMSCHEID, Craig A.:Penn Med, Philadelphia, PA USA
· NASIR, Khurram:John Hopkins Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA; Baptist Hlth South Florida, Miami, FL USA
· BLANKSTEIN, Ron:Harvard Med Sch, Cardiovasc Imaging Program, Div Cardiovasc Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA
hcfmusp.origem.id WOS:000407044400001
hcfmusp.origem.id 2-s2.0-85026876917
hcfmusp.publisher.city NEW YORK
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
dc.identifier.eissn 1876-7591
hcfmusp.citation.scopus 31
hcfmusp.citation.wos 31
hcfmusp.affiliation.country Brasil
hcfmusp.affiliation.country Estados Unidos


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