Highlights
- •Statins may increase calcification in mechanistic and imaging studies.
- •The impact of statins on coronary artery calcium (CAC) predictive value is unclear.
- •CAC scoring retains utility for risk prediction in statin users.
- •The slightly weaker relationship of CAC with outcomes in statin users may be explained by changes in CAC density.
Abstract
Background and aims
Statins do not decrease coronary artery calcium (CAC) and may increase existing calcification
or its density. Therefore, we examined the prognostic significance of CAC among statin
users at the time of CAC scanning.
Methods
We included 28,025 patients (6151 statin-users) aged 40–75 years from the CAC Consortium.
Cox regression models were used to assess the association of CAC with coronary heart
disease (CHD) and cardiovascular disease (CVD) mortality. Models were adjusted for
traditional CVD risk factors. Additionally, we examined the predictive performance
of CAC components including CAC area, volume, and density using an age- and sex-adjusted
Cox regression model.
Results
Participants (mean age 53.9 ± 10.3 years, 65.0% male) were followed for median 11.2
years. There were 395 CVD and 182 CHD deaths. One unit increase in log CAC score was
associated with increased risk of CVD mortality (hazard ratio (HR), 1.2; 95% CI = 1.1–1.3)
and CHD mortality (HR, 1.2; 95% CI = 1.1–1.4)) among statin users. There was a small
but significant negative interaction between CAC score and statin use for the prediction
of CHD (p-value = 0.036) and CVD mortality (p-value = 0.025). The volume score and CAC area were similarly associated with outcomes
in statin users and non-users. Density was associated with CVD and CHD mortality in
statin naïve patients, but with neither in statin users.
Conclusion
CAC scoring retains robust risk prediction in statin users, and the changing relationship
of CAC density with outcomes may explain the slightly weaker relationship of CAC with
outcomes in statin users.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 10, 2020
Accepted:
October 7,
2020
Received in revised form:
September 30,
2020
Received:
July 28,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
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- Statins and coronary artery calcium: What's the score?AtherosclerosisVol. 316
- PreviewIn this issue of Atherosclerosis, Osei et al. sought to understand the prognostic value of coronary artery calcium (CAC) for predicting risk among individuals already on statin therapy [1]. Risk assessment is the bedrock of primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, observations over the last two decades consistently suggest that quantitative risk assessment with a variety of clinical risk scores is imprecise and can lead to systematic under- or overestimation of events.
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