%0 Journal Article
%T Implications of coronary artery calcium testing on risk stratification for lipid
%A Arthur S Agatston
%A Harlan M Krumholz
%A Khurram Nasir
%A Marcio S Bittencourt
%A Matthew J Budoff
%A Michael J Blaha
%A Roger S Blumenthal
%A Ron Blankstein
%A Veit Sandfort
%J European Journal of Preventive Cardiology
%@ 2047-4881
%D 2018
%R 10.1177/2047487318788930
%X The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended (N£¿=£¿2228), consider lipid-lowering treatment if uncontrolled (N£¿=£¿1686), or lipid-lowering treatment recommended (N£¿=£¿1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1¨C100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium
%K Cardiovascular disease
%K coronary artery calcium
%K risk stratification
%K primary prevention
%U https://journals.sagepub.com/doi/full/10.1177/2047487318788930