Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study

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art_BITTENCOURT_Implications_of_coronary_artery_calcium_testing_on_risk_2018.PDF (608.65 KB)
Citações na Scopus
22
Tipo de produção
article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SAGE PUBLICATIONS LTD
Autores
BLANKSTEIN, Ron
BLAHA, Michael J.
SANDFORT, Veit
AGATSTON, Arthur S.
BUDOFF, Matthew J.
BLUMENTHAL, Roger S.
KRUMHOLZ, Harlan M.
NASIR, Khurram
Citação
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, v.25, n.17, p.1887-1898, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Aims The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N = 2228), consider lipid-lowering treatment if uncontrolled (N = 1686), or lipid-lowering treatment recommended (N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1-100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). Conclusion The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.
Palavras-chave
Cardiovascular disease, coronary artery calcium, risk stratification, primary prevention
URI
https://observatorio.fm.usp.br/handle/OPI/32628
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Coleções
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - ODS/03