- •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.
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.
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.
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.
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.
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- AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood Cholesterol: executive summary: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines.J. Am. Coll. Cardiol. 2018; 73 (2019): 3168-3209https://doi.org/10.1016/j.jacc.2018.11.002
- Effects of statins on coronary atherosclerotic plaques: the PARADIGM study.JACC Cardiovasc Imaging. 2018; 11: 1475-1484https://doi.org/10.1016/j.jcmg.2018.04.015
- Coronary artery calcium progression: an important clinical measurement?.J. Am. Coll. Cardiol. 2010; 56: 1613-1622https://doi.org/10.1016/j.jacc.2010.06.038
- Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies.BMC Med. 2015; https://doi.org/10.1186/s12916-015-0459-4
- Rationale and design of the coronary artery calcium consortium: a multicenter cohort study.J Cardiovasc Comput Tomogr. 2017; 11: 54-61https://doi.org/10.1016/j.jcct.2016.11.004
- Calcium density of coronary artery plaque and risk of incident cardiovascular events.JAMA, J. Am. Med. Assoc. 2014; 311: 271-278https://doi.org/10.1001/jama.2013.282535
- Impact of statins on serial coronary calcification during atheroma progression and regression.J. Am. Coll. Cardiol. 2015; 65: 1273-1282https://doi.org/10.1016/j.jacc.2015.01.036
- Coronary artery calcium and cardiovascular events in patients with familial hypercholesterolemia receiving standard lipid-lowering therapy.JACC Cardiovasc Imaging. 2019; 12: 1797-1804https://doi.org/10.1016/j.jcmg.2018.09.019
- Coronary artery calcification, statin use and long-term risk of atherosclerotic cardiovascular disease events (from the multi-ethnic study of Atherosclerosis).Am. J. Cardiol. December 2019; https://doi.org/10.1016/j.amjcard.2019.12.031
- Coronary artery calcium scoring: is it time for a change in methodology?.JACC Cardiovasc Imaging. 2017; 10: 923-937https://doi.org/10.1016/j.jcmg.2017.05.007
- Effect of evolocumab on coronary plaque composition.J. Am. Coll. Cardiol. 2018; https://doi.org/10.1016/j.jacc.2018.06.078
- Personalizing treatment: between primary and secondary prevention.Am. J. Cardiol. 2016; 118: 4A-12Ahttps://doi.org/10.1016/j.amjcard.2016.05.026
- Coronary artery calcium for personalized allocation of aspirin in primary prevention of cardiovascular disease in 2019: the multi-ethnic study of Atherosclerosis (MESA).Circulation. April 2020; 119 (CIRCULATIONAHA)045010https://doi.org/10.1161/CIRCULATIONAHA.119.045010
- ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines.Hypertension. 2017; 71 (2018): 1269-1324https://doi.org/10.1161/HYP.0000000000000066
- Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihypertensive therapy.Circulation. 2017; 135: 153-165https://doi.org/10.1161/CIRCULATIONAHA.116.025471
- Role of coronary artery calcium for stratifying cardiovascular risk in adults with hypertension: the coronary artery calcium consortium.Hypertension. 2019; 73: 983-989https://doi.org/10.1161/HYPERTENSIONAHA.118.12266
- ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.Eur. Heart J. 2019; 41 (2020): 111-188https://doi.org/10.1093/eurheartj/ehz455
Published online: October 10, 2020
Accepted: October 7, 2020
Received in revised form: September 30, 2020
Received: July 28, 2020
© 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 . 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.