Author + information
- Gowtham Grandhi,
- Anshul Saxena,
- Tanuja Rajan,
- Emir Veledar,
- Amit Khera,
- Ron Blankstein,
- Roger Blumenthal,
- Leslee Shaw,
- Michael Blaha and
- Khurram Nasir
Recent studies have strongly eluded to the importance of absent coronary artery calcium (CAC) in risk reclassification of statin eligible (10-years atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5%) individuals according to the ACC/AHA cholesterol management guidelines. In this systematic review, we aim to summarize the impact of absence of CAC in the reclassification of these individuals to statin non-eligible.
We included prospective cohort studies with a follow-up of at least 10 years, which have reported data on statin eligibility according to the 2013 AHA/ACC guidelines, with additional data on CAC distribution and ASCVD events.
Overall 4 prospective studies were considered (table). Among a pooled sample of 6,230 individuals statin recommended individuals, 1,985 (32%, 95% CI: 21%-45%) had CAC=0 (range 18.7% to 41.1%). They were followed for 97 to 130 months (mean 10 years). Overall, 84 of 1,985 participants (4.2%, 95% CI: 2%-6%) without CAC had an ASCVD event, as compared with 426 of 4,245 (10%, 95% CI: 9%-11%) with CAC. The cumulative relative risk ratio was 0.43 (95% CI: 0.31-0.58, p < 0.001) (Figure).
The meta-analysis of 4 prospective cohort studies demonstrated >50% lower ASCVD risk in statin eligible subjects with CAC = 0 compared to those with CAC > 0. These results support emerging consensus that CAC = 0 reclassifies risk of statin candidates below the threshold of statin recommendation (i.e. <5%), allowing flexibility in management decisions.
Poster Hall, Hall A/B
Monday, March 12, 2018, 9:45 a.m.-10:30 a.m.
Session Title: Coronary Calcium: Diagnosis and Prognosis
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1293-315
- 2018 American College of Cardiology Foundation