Author + information
- Received May 8, 2018
- Revision received September 23, 2018
- Accepted September 25, 2018
- Published online December 17, 2018.
- Joshua D. Mitchell, MDa,∗ (, )@joshmitchellmd,
- Nicole Fergestrom, MSb,
- Brian F. Gage, MDc,
- Robert Paisley, MDd,
- Patrick Moon, MDe,
- Eric Novak, MSa,
- Michael Cheezum, MDf,
- Leslee J. Shaw, PhDg@lesleejshaw and
- Todd C. Villines, MDh
- aCardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
- bCenter for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
- cGeneral Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
- dGeneral Internal Medicine Section, Baylor College of Medicine, Houston, Texas
- eInternal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- fCardiology Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- gEmory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
- hCardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- ↵∗Address for correspondence:
Dr. Joshua D. Mitchell, Division of Cardiology, Washington University in St. Louis, 660 South Euclid Avenue, CB 8086, St. Louis, Missouri 63110.
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.
This work was supported by a National Institutes of Health Clinical and Translational Science Award grant (UL1 TR002345). Originally affiliated with Washington University in St. Louis, Dr. Novak is currently an employee of W.L. Gore & Associates. Dr. Villines has received an honorarium from Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received May 8, 2018.
- Revision received September 23, 2018.
- Accepted September 25, 2018.
- 2018 American College of Cardiology Foundation
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