Yonsei Med J.  2017 Jan;58(1):82-89. 10.3349/ymj.2017.58.1.82.

Assessment of Coronary Artery Calcium Scoring for Statin Treatment Strategy according to ACC/AHA Guidelines in Asymptomatic Korean Adults

• Han D
• Ó Hartaigh B
• Lee JH
• Rizvi A
• Park HE
• Choi SY
• Sung J
• Chang HJ

• KMID: 2374192
• DOI: http://doi.org/10.3349/ymj.2017.58.1.82

Abstract

PURPOSE
The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines advocate the use of statin treatment for prevention of cardiovascular disease. We aimed to assess the usefulness of coronary artery calcium (CAC) for stratifying potential candidates of statin use among asymptomatic Korean individuals.
MATERIALS AND METHODS
A total of 31375 subjects who underwent CAC scoring as part of a general health examination were enrolled in the current study. Statin eligibility was categorized as statin recommended (SR), considered (SC), and not recommended (SN) according to ACC/AHA guidelines. Cox regression analysis was employed to estimate hazard ratios (HR) with 95% confidential intervals (CI) after stratifying the subjects according to CAC scores of 0, 1-100, and >100. Number needed to treat (NNT) to prevent one mortality event during study follow up was calculated for each group.
RESULTS
Mean age was 54.4±7.5 years, and 76.3% were male. During a 5-year median follow-up (interquartile range; 3-7), there were 251 (0.8%) deaths from all-causes. A CAC >100 was independently associated with mortality across each statin group after adjusting for cardiac risk factors (e.g., SR: HR, 1.60; 95% CI, 1.07-2.38; SC: HR, 2.98; 95% CI, 1.09-8.13, and SN: HR, 3.14; 95% CI, 1.08-9.17). Notably, patients with CAC >100 displayed a lower NNT in comparison to the absence of CAC or CAC 1-100 in SC and SN groups.
CONCLUSION
In Korean asymptomatic individuals, CAC scoring might prove useful for reclassifying patient eligibility for receiving statin therapy based on updated 2013 ACC/AHA guidelines.

Keyword

Coronary artery disease; risk assessment; calcium; hydroxymethylglutaryl-CoA reductase inhibitor

MeSH Terms

Aged
American Heart Association
Cardiovascular Diseases/*prevention & control
Cause of Death
Confidence Intervals
Coronary Artery Disease/*diagnosis
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
Male
Middle Aged
Numbers Needed To Treat
Practice Guidelines as Topic
Regression Analysis
Republic of Korea
Risk Assessment
Risk Factors
United States
Vascular Calcification/*diagnosis
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

• 

  Fig. 1 Study flow chart of participant groups. KOICA, KOrea Initiative on Coronary Artery calcification; CAD, coronary artery disease; ASCVD, atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol; CAC, coronary artery calcium.

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  Fig. 2 Distribution of coronary artery calcium scores according to statin candidate groups. CAC, coronary artery calcium.

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  Fig. 3 Incident mortality (per 1000 person-years) according to coronary artery calcium scores, and stratified by statin candidate groups. CAC, coronary artery calcium.

• 

  Fig. 4 Kaplan-Meier survival curves according to coronary artery calcium scores and statin candidate groups. CAC, coronary artery calcium.

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