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Coronary Artery Calcium Might Help Identify Low-Risk Patients Who Would Benefit from Statins

CAC might be more useful than high-sensitivity C-reactive protein.

In the placebo-controlled JUPITER trial (JW Gen Med Nov 18 2008), rosuvastatin (Crestor) significantly lowered the incidence of adverse cardiovascular events in healthy patients with normal levels of LDL cholesterol (<130 mg/dL) and elevated levels of high-sensitivity C-reactive protein (hsCRP; 2 mg/L). These results — if applied widely — would result in statin therapy for millions of patients at relatively low cardiovascular risk. But, because absolute event rates were low, most such patients would derive no benefit. To determine whether computed tomography (CT)-identified coronary artery calcium (CAC) might define a subgroup of JUPITER-eligible patients who would be most likely to benefit from statin therapy, investigators identified 950 participants in a prospective cohort study of subclinical atherosclerosis who met JUPITER criteria; baseline CT-based CAC analysis was performed in each participant.

During a median follow-up of 6 years, the 25% of patients with baseline CAC scores >100 accounted for 74% of adverse coronary events and 60% of cardiovascular events. Relatively few events occurred in the 47% of patients with CAC scores of zero. Applying the effect of rosuvastatin treatment from the JUPITER trial to this study population, the number needed to treat (NNT) to prevent one adverse coronary event was 549 for CAC scores of zero, 94 for scores of 1–100, and 24 for scores >100. To prevent one adverse cardiovascular event, the NNTs were 124, 54, and 19.

Comment: Coronary artery calcium probably is more useful than hsCRP in targeting statins and other interventions to low-risk patients who could derive the most benefit. However, clinical trials are required to confirm this assumption, and clear risk-stratification algorithms remain to be established.

— Bruce Soloway, MD

Published in Journal Watch General Medicine August 30, 2011

Citation(s):

Blaha MJ et al. Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: Implications for the JUPITER population from MESA, a population-based cohort study. Lancet 2011 Aug 20; 378:684. (http://dx.doi.org/10.1016/S0140-6736(11)60784-8)

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Review and add to remarks on this article

• Heart Vessel Calcium Studies
  Bernard A. Yablin, Retired--Asst.Clin.Prof-URMC, 31 Aug 2011 12:08 PM EST
  Specialty: Pediatrics
  So far,is there any established price/benefit ratio of these studies?

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