Márcio Sommer Bittencourt1, Michael J Blaha2, Ron Blankstein1, Matthew Budoff3, Jose D Vargas4, Roger S Blumenthal2, Arthur S Agatston5, Khurram Nasir6. 1. Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 2. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. 3. Division of Cardiology, Los Angeles Biomedical Research Institute at Harbour-UCLA, Torrance, California. 4. Cardiology Division, Johns Hopkins Hospital, Baltimore, Maryland; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland. 5. Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. 6. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Baptist Cardiovascular Institute, Baptist Health South Florida, Miami, Florida. Electronic address: knasir1@jhmi.edu.
Abstract
OBJECTIVES: This study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill. BACKGROUND: Prior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level. METHODS: Participants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score. RESULTS: Among MESA participants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC = 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC = 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores >100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC = 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores >100. CONCLUSIONS: In MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores >100. The group with CAC = 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC = 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit.
OBJECTIVES: This study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill. BACKGROUND: Prior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level. METHODS:Participants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score. RESULTS: Among MESAparticipants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC = 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC = 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores >100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC = 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores >100. CONCLUSIONS: In MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores >100. The group with CAC = 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC = 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit.
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