Joshua D Mitchell1, Nicole Fergestrom2, Brian F Gage3, Robert Paisley4, Patrick Moon5, Eric Novak6, Michael Cheezum7, Leslee J Shaw8, Todd C Villines9. 1. Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. Electronic address: jdmitchell@wustl.edu. 2. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri. 4. General Internal Medicine Section, Baylor College of Medicine, Houston, Texas. 5. Internal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland. 6. Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. 7. Cardiology Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia. 8. Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia. Electronic address: https://twitter.com/lesleejshaw. 9. Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
Abstract
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.
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.
Authors: Michael C Honigberg; Bradley S Lander; Vinit Baliyan; Maeve Jones-O'Connor; Emma W Healy; Jan-Erik Scholtz; John T Nagurney; Udo Hoffmann; Brian B Ghoshhajra; Pradeep Natarajan Journal: JACC Cardiovasc Imaging Date: 2019-07-17
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2019-03-17 Impact factor: 24.094
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Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: Circulation Date: 2019-03-17 Impact factor: 29.690
Authors: Adrián I Löffler; Jorge A Gonzalez; Shriram K Sundararaman; Roshin C Mathew; Patrick T Norton; Klaus D Hagspiel; Christopher M Kramer; Michael Ragosta; Campbell Rogers; Neeral L Shah; Michael Salerno Journal: Liver Transpl Date: 2020-11 Impact factor: 5.799