Left Main Coronary Artery Calcium and Diabetes Confer Very-High-Risk Equivalence in Coronary Artery Calcium >1,000.
JACC Cardiovasc Imaging
; 17(7): 766-776, 2024 Jul.
Article
em En
| MEDLINE
| ID: mdl-38385932
ABSTRACT
BACKGROUND:
Although a coronary artery calcium (CAC) of ≥1,000 is a subclinical atherosclerosis threshold to consider combination lipid-lowering therapy, differentiating very high from high atherosclerotic cardiovascular disease (ASCVD) risk in this patient population is not well-defined.OBJECTIVES:
Among persons with a CAC of ≥1,000, the authors sought to identify risk factors equating with very high-risk ASCVD mortality rates.METHODS:
The authors studied 2,246 asymptomatic patients with a CAC of ≥1,000 from the CAC Consortium without a prior ASCVD event. Cox proportional hazards regression modelling was performed for ASCVD mortality during a median follow-up of 11.3 years. Crude ASCVD mortality rates were compared with those reported for secondary prevention trial patients classified as very high risk, defined by ≥2 major ASCVD events or 1 major event and ≥2 high-risk conditions (1.4 per 100 person-years).RESULTS:
The mean age was 66.6 years, 14% were female, and 10% were non-White. The median CAC score was 1,592 and 6% had severe left main (LM) CAC (vessel-specific CAC ≥300). Diabetes (HR 2.04 [95% CI 1.47-2.83]) and severe LM CAC (HR 2.32 [95% CI 1.51-3.55]) were associated with ASCVD mortality. The ASCVD mortality per 100 person-years for all patients was 0.8 (95% CI 0.7-0.9), although higher rates were observed for diabetes (1.4 [95% CI 0.8-1.9]), severe LM CAC (1.3 [95% CI 0.6-2.0]), and both diabetes and severe LM CAC (7.1 [95% CI 3.4-10.8]).CONCLUSIONS:
Among asymptomatic patients with a CAC of ≥1,000 without a prior index event, diabetes, and severe LM CAC define very high risk ASCVD, identifying individuals who may benefit from more intensive prevention therapies across several domains, including low-density lipoprotein-cholesterol lowering.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Valor Preditivo dos Testes
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Angiografia Coronária
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Diabetes Mellitus
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Calcificação Vascular
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
JACC Cardiovasc Imaging
/
JACC cardiovasc imaging (Print)
/
JACC. cardiovascular imaging (Print)
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
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DIAGNOSTICO POR IMAGEM
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos